Combined active and passive immunotherapy in honeybee-sting allergy

Five honeybee sting-allergic patients in whom bee venom immunotherapy (VIT) had previously been stopped because of repeated allergic side effects (SE) were resubmitted to bee VIT after pretreatment with beekeeper gammaglobulin. The tolerated bee venom dose was increased five to 800 times after this passive immunotherapy, and the maintenance dose of 100 micrograms of honeybee venom (BV) was reached in all patients after 6 to 15 days of a rush hyposensitization. The IgG response to BV was not suppressed by the beekeeper-gammaglobulin infusion. After 2 to 9 weeks of continued bee VIT, SE recurred in all patients. Therapy had to be stopped in one patient. The other four patients are currently on a maintenance dose of 60 to 80 micrograms. The possibility of a qualitative inferiority of the patients own IgG response was studied by crossed radioimmunoelectrophoresis and IgG subclass analysis. Lack of an IgG response to particular BV components to which IgE was present was demonstrated in three patients. The IgG subclass antibody pattern to BV at the time of recurrence of SE was similar to that found in beekeepers with a prominent IgG4 response. In contrast to beekeepers, however, there was no IgG2 response in patients.