The Clinical Importance of Component-Based Diagnostic Test in Patients Planned for Venom Immunotherapy

Venom immunotherapy (VIT) is the most effective treatment approach for preventing severe systemic reactions caused by hymenoptera stings. In some cases, the detection of specific immunoglobulin E (IgE) positivity for both honeybee and wasp venoms can create diagnostic and therapeutic challenges. In this study, we aimed to evaluate the effectiveness of the Immulite 2000 3g Allergy component-based diagnostic test (CBDT) in determining true sensitization in patients with dual venom positivity who were scheduled for VIT.

In this prospective study, 66 patients who presented to the Immunology and Allergy Diseases outpatient clinic between January 2019 and December 2024 with a history of systemic reaction following a bee sting and who were indicated for VIT were evaluated.

The mean age of the patients was 46.3 ± 12.9 years, with a male predominance. Honeybee stings were the most common (50%). Forty-two patients had single-venom sensitization, while 22 had specific IgE positivity for both Apis mellifera and Vespula vulgaris. According to the CBDT results, 6 of the 22 patients had dual sensitization, while 7 patients had sensitization only to Vespula. Patients with indeterminate venom sensitization had higher Api m 1/Ves v 5 specific IgE ratios.

In our study, using the Immulite 2000 3g Allergy CBDT results, venom sensitization could not be clearly determined in 41% of patients with dual sensitization to venom allergens, and true double sensitization was identified in only 27% of these patients. Therefore, we suggest that including additional species-specific antigens (especially Ves v 1) alongside in the Immulite 2000 3g Allergy CBDT panel could improve the detection of true sensitization. Furthermore, when supported by accurate and reliable clinical history, a specific IgE Api m 1/Ves v 5 ratio greater than 5 can represent a significant and useful hypothesis. However, further studies are needed to confirm this hypothesis.