Molecular Diagnosis in Hymenoptera Allergy: Comparison of Euroline DPA-Dx and ImmunoCAP

The efficacy of Hymenoptera venom immunotherapy is contingent upon the accurate identification of the insect responsible for the allergic reaction. The techniques used to detect specific IgE suffer from difficulties due to the cross-reactivity between Hymenoptera venoms (false positives), diagnostic ability, and the limited availability of allergenic components (false negatives). In this study, we analyzed the discrepancies in the results obtained with Euroline^® DPA-Dx and ImmunoCAP^® in the diagnosis of allergic reactions due to Hymenoptera stings in 151 patients. The results (positive/negative) of ImmunoCAP^® and Euroline^® agreed in 77/151 (50.99%) cases; with 15/151 (9.93%) cases positive for the same insect, and 61/151 (40.4%) cases positive for multiple insects. When the results were used to decide which venom to use for immunotherapy, there was a statistically significant discrepancy for Polistes dominula (21.8% of cases with ImmunoCAP^® compared to only 8.4% with Euroline^®). The presence of Polistes venom phospholipase (Pol d 1) in Euroline^® did not increase its ability to differentiate double sensitization to wasps. ImmunoCAP^® and Euroline^® exhibited comparable diagnostic performance in bee venom allergy. For vespid venom allergy-particularly involving Polistes species-ImmunoCAP^® appeared to show a slight diagnostic advantage, although this finding should be interpreted with caution.