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410 Hymenoptera allergy: Diagnostic evaluation
408
ATOPIC ALLERGIC REACTIONSDUE TO POTATO c. ca:tcl:s. MD. C. Pascunl. MD. M. Martin Esteban, MD, A.‘Ojeda, MD, Madrid, Spain. !I 11 vears old girl. breast-fed for her first eight months, developed anaphylactic symptoms related to potato. These began at the age of 5 months when she ate potato for the first time. Since them, contact with potato peel caused urticaria and angioedema, ingestion of food with potato as additive provoked vomiting, asthnm or shock and inhalation of steam fro,1 cooking potatoes or beeing in a rural area during potato polinization period causes rhinoconjonctivitis and as time . ‘Total serum IgE was 800 kU/L. Three allergenic extracts from potato peel, pulp and pollen were prepared. Positive skin prick test with them were found, negative with others pollens, positive PAST for potato pollen and pulp and positive leukocyte histamine release. RAST inhibition for pulp and pollen antigens was achieved with each respective allergen. Pulp inhibit PAST to pollen allergen, whereas pollen did not Passive transfer inhibit RAST to nulu allergen. (PK) was positive and Walzer reaction was observed in PK recipient during 48 days, when reci-pient ate food-containing-potato. At day 60, when Walzer became neeativePK was -still posirivr;. In conclusion, this-patient is sensitized to antigens being in pulp, peel and potato pollen. Sensitization way could be through breast ieeding. Walzer reaction suggests the presence of hidden potato in several foods, the crossing of antigen through intestinal barrier eveninadults and the persistence of IgE passively transferred longer than usual.
ANALYSIS OF 677 DEATH CERTIFICATES AND 168 AUTOPSIES OF STINGING INSECT DEATHS. T; From 1962 to 1982 the Committee on Insects-collected 677 death certificates 8 168 autopsy reports related to hymenoptera sting(s) from 47 states and D.C. None The autopsy rate averaged 30%. were reported from ALA, VT, or WY. 79% were male, 20% fem., 1% unclassified. Of the males 79.9% were white, 9% black, 11% unclassified; of 0.1% Amerindian, females 78% white, 4% black, 0.7% orienThese data were 17.3% unclass.. tal, comparable when broken into 5 yr periods. Age range: 3-93 yrs with the greatest # between 51-75 yrs (48%)) and least beIn black males the tween 3-10 (2%). greatest # occurred between 26-50 yrs 9% of deaths occurred in subjs. (66%). with hx of reaction to stings in past. 14% of these had been treated with WBE. Autopsy analyses showed that the primary pathology was respiratory (54%),anaphylaxis (34901, vascular (8%), or neurolonic (4%). 59% of resp. 6 63% of anaph. die; in‘lst hr post-sting; 81% of vast. and 89% of neuro. died after the 1st hr. Single sting 57% of-all died in 1st hr. was more likely to cause death from resp. whereas multiple stings causes (edema), were more likely to cause death from ana. 63% of pts in whom # of stings (shock). Through period of was known had only 1. study relation of deaths was the same: resp. ) anaph. > vast.) neuro.
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HYMENOPTERA ALLERGY:DIAGNOSTICEVALlJATION.E.Pasto rello,M.D.,C.Ortolani,M.D.,C.IncorVaia,M.~.~MT.Lu ---..raghi,M.D.,V.Sillano,M.D.,Milan,It-2l.y
Results: lYh alle.rgics czd-m&d a clinical i!Lrx-sw with slsbecpients~ in 77.8,th.e Esak?rezticfi in19.2, &an ifrpwmt in ally 4.5; 2m- the patients EGtE@oted of being allergictobeesting5in%wfcunda~lete~ ofpitivitybetweenST,F@SF&history far HBVtileat tire ~ti&zwingrx,positivi~to~&R4sTfarotheri.nsects.we fcarkdasik.lar ocmadame in67%ofptients al.& gic tovespidvarm.3)Be~allergicsandrrarall~c beekeepers the avv HBVspecific I,$ wre similar (0.673 cd in allergies wdO.573 inxnallergics),buttkeH&apecific IgE meanlevels were hi&y si@ficantly different (in tiler gics 27.6Xspecific tx~ti (sb)and in rxn allergies 9.1%ab):pO.0331; 4)lhe r-m allergic beekeepers szlxxsi:a)h the g-eat majority (89.@)a ~~&XCY tomaintain rn" tie the size of thelccalI-eacticncn sl$sequent skingqkwe only 10.4 show edauDlseningofii?elccal rezctias; b)si@ificzmtlyhig& levelsofI~tQH6vafterthebee seaHm kiverage values be_ fore aeasofk0.47l c&after 0.776: pO.Ol)tith a parallel ckcreaseoflocal~ticns.Thisstujya&ge5tst2lattheptientswitia cxmnr&me ofRASI‘,ST&histoq sku.ldbeaelect. edfor~~after~firstsys~~c~t~blarafter5+wBingof~quentlargerloral reacticrls 411
207
FURTHER STUDIES OF PATIENTS WITH BOTH HQMEYBEE AND YELLOW JACKET VENOM-SPECIFIC IgE. Robert E. Reisman, M.D., and Mary I. Laze11 B S MS., __..? .--.I-'--' Buffalo. NY Previous studies of sera of pts with coexisting honeybee and yellow jacket venom-specific IgE have shown 3 patterns of specificity. This report extends that data and identifies a fourth pattern of crossreactivity. Seventeen sera from pts with high titers of both honeybee and yellow jacket venom-specific IgE were analyzed in RAST inhibition experiments, using each venom as the coupling and inhibiting antigen. Six sera had unique Ah activity withno crossreactivity between yellow jacket and honeybee venom-specific IgE. Tn 3 set-a. the IaE Ab activity was directed at a major ailergenlinyellow jacket venom crossreacting with a minor allergen in honeybee venom. Bee venom inhibited only the bee venom RAST, yellow jacket venom inhibited both the honeybeeandyellow jacket venom RAST. Four sera showed the opposite pattern with IgE Ab directed at a major allergen in honeybee venom crossreacting with a minor allergen inyelThe fourth newly observed low jacket venom. pattern was that of extensive IqE crossreaction. Both honeybee venom and yellow jacket venom inhibited both the honeybee and vellow jacket venom RASTs. There were no clinical features such as age, sex, atopy or type of anaphylacticsymptomswhich could distinguish pts in each qroup. All but one pt had a history of multiple sting. exposures. These data suggest multiole allerqens in bee and yellow jacket venom with major and minor crossreactions and have important implications for proper venom immunotherapy.
ATOPIC ALLERGIC REACTIONSDUE TO POTATO c. ca:tcl:s. MD. C. Pascunl. MD. M. Martin Esteban, MD, A.‘Ojeda, MD, Madrid, Spain. !I 11 vears old girl. breast-fed for her first eight months, developed anaphylactic symptoms related to potato. These began at the age of 5 months when she ate potato for the first time. Since them, contact with potato peel caused urticaria and angioedema, ingestion of food with potato as additive provoked vomiting, asthnm or shock and inhalation of steam fro,1 cooking potatoes or beeing in a rural area during potato polinization period causes rhinoconjonctivitis and as time . ‘Total serum IgE was 800 kU/L. Three allergenic extracts from potato peel, pulp and pollen were prepared. Positive skin prick test with them were found, negative with others pollens, positive PAST for potato pollen and pulp and positive leukocyte histamine release. RAST inhibition for pulp and pollen antigens was achieved with each respective allergen. Pulp inhibit PAST to pollen allergen, whereas pollen did not Passive transfer inhibit RAST to nulu allergen. (PK) was positive and Walzer reaction was observed in PK recipient during 48 days, when reci-pient ate food-containing-potato. At day 60, when Walzer became neeativePK was -still posirivr;. In conclusion, this-patient is sensitized to antigens being in pulp, peel and potato pollen. Sensitization way could be through breast ieeding. Walzer reaction suggests the presence of hidden potato in several foods, the crossing of antigen through intestinal barrier eveninadults and the persistence of IgE passively transferred longer than usual.
ANALYSIS OF 677 DEATH CERTIFICATES AND 168 AUTOPSIES OF STINGING INSECT DEATHS. T; From 1962 to 1982 the Committee on Insects-collected 677 death certificates 8 168 autopsy reports related to hymenoptera sting(s) from 47 states and D.C. None The autopsy rate averaged 30%. were reported from ALA, VT, or WY. 79% were male, 20% fem., 1% unclassified. Of the males 79.9% were white, 9% black, 11% unclassified; of 0.1% Amerindian, females 78% white, 4% black, 0.7% orienThese data were 17.3% unclass.. tal, comparable when broken into 5 yr periods. Age range: 3-93 yrs with the greatest # between 51-75 yrs (48%)) and least beIn black males the tween 3-10 (2%). greatest # occurred between 26-50 yrs 9% of deaths occurred in subjs. (66%). with hx of reaction to stings in past. 14% of these had been treated with WBE. Autopsy analyses showed that the primary pathology was respiratory (54%),anaphylaxis (34901, vascular (8%), or neurolonic (4%). 59% of resp. 6 63% of anaph. die; in‘lst hr post-sting; 81% of vast. and 89% of neuro. died after the 1st hr. Single sting 57% of-all died in 1st hr. was more likely to cause death from resp. whereas multiple stings causes (edema), were more likely to cause death from ana. 63% of pts in whom # of stings (shock). Through period of was known had only 1. study relation of deaths was the same: resp. ) anaph. > vast.) neuro.
4 10
HYMENOPTERA ALLERGY:DIAGNOSTICEVALlJATION.E.Pasto rello,M.D.,C.Ortolani,M.D.,C.IncorVaia,M.~.~MT.Lu ---..raghi,M.D.,V.Sillano,M.D.,Milan,It-2l.y
Results: lYh alle.rgics czd-m&d a clinical i!Lrx-sw with slsbecpients~ in 77.8,th.e Esak?rezticfi in19.2, &an ifrpwmt in ally 4.5; 2m- the patients EGtE@oted of being allergictobeesting5in%wfcunda~lete~ ofpitivitybetweenST,F@SF&history far HBVtileat tire ~ti&zwingrx,positivi~to~&R4sTfarotheri.nsects.we fcarkdasik.lar ocmadame in67%ofptients al.& gic tovespidvarm.3)Be~allergicsandrrarall~c beekeepers the avv HBVspecific I,$ wre similar (0.673 cd in allergies wdO.573 inxnallergics),buttkeH&apecific IgE meanlevels were hi&y si@ficantly different (in tiler gics 27.6Xspecific tx~ti (sb)and in rxn allergies 9.1%ab):pO.0331; 4)lhe r-m allergic beekeepers szlxxsi:a)h the g-eat majority (89.@)a ~~&XCY tomaintain rn" tie the size of thelccalI-eacticncn sl$sequent skingqkwe only 10.4 show edauDlseningofii?elccal rezctias; b)si@ificzmtlyhig& levelsofI~tQH6vafterthebee seaHm kiverage values be_ fore aeasofk0.47l c&after 0.776: pO.Ol)tith a parallel ckcreaseoflocal~ticns.Thisstujya&ge5tst2lattheptientswitia cxmnr&me ofRASI‘,ST&histoq sku.ldbeaelect. edfor~~after~firstsys~~c~t~blarafter5+wBingof~quentlargerloral reacticrls 411
207
FURTHER STUDIES OF PATIENTS WITH BOTH HQMEYBEE AND YELLOW JACKET VENOM-SPECIFIC IgE. Robert E. Reisman, M.D., and Mary I. Laze11 B S MS., __..? .--.I-'--' Buffalo. NY Previous studies of sera of pts with coexisting honeybee and yellow jacket venom-specific IgE have shown 3 patterns of specificity. This report extends that data and identifies a fourth pattern of crossreactivity. Seventeen sera from pts with high titers of both honeybee and yellow jacket venom-specific IgE were analyzed in RAST inhibition experiments, using each venom as the coupling and inhibiting antigen. Six sera had unique Ah activity withno crossreactivity between yellow jacket and honeybee venom-specific IgE. Tn 3 set-a. the IaE Ab activity was directed at a major ailergenlinyellow jacket venom crossreacting with a minor allergen in honeybee venom. Bee venom inhibited only the bee venom RAST, yellow jacket venom inhibited both the honeybeeandyellow jacket venom RAST. Four sera showed the opposite pattern with IgE Ab directed at a major allergen in honeybee venom crossreacting with a minor allergen inyelThe fourth newly observed low jacket venom. pattern was that of extensive IqE crossreaction. Both honeybee venom and yellow jacket venom inhibited both the honeybee and vellow jacket venom RASTs. There were no clinical features such as age, sex, atopy or type of anaphylacticsymptomswhich could distinguish pts in each qroup. All but one pt had a history of multiple sting. exposures. These data suggest multiole allerqens in bee and yellow jacket venom with major and minor crossreactions and have important implications for proper venom immunotherapy.