- Email: [email protected]
Allergy to Hymenoptera Venom and HLA Class II Association
112
Mean Wheal Size and Concentration at Positive as Risk Factors for Systemic Reaction with Imported Fire Ant Whole Body Extract Immunotherapy J. J. Sacha, E. Reyes; Wilford Hall Medical Center, San Antonio, TX. RATIONALE: To determine if initial skin test mean wheal size (MWS) or concentration at which test was positive are predictive of increased risk for future systemic reactions with imported fire ant (IFA) whole body extract (WBE) immunotherapy which could allow physicians to modify immunotherapy treatment schedules to limit risk and for more accurate risk management communication to patients when discussing IFA immunotherapy. METHODS: We reviewed retrospective data from patients receiving exclusively IFA WBE immunotherapy in an existing electronic medical database to determine the incidence of systemic reactions (SR) in this population, their initial positive skin test MWS, and the extract concentration at which the patient’s test was positive. Unpaired t test was utilized to determine if MWS with initial skin test or concentration at which the skin test was positive were predictive of future SR. RESULTS: Eighty-one patients met inclusion criteria, with 3 patients experiencing SR. MWS ranged from 3 to 17.5 mm in those patients without SR, while in those patients with SR MWS ranged from 5 to 6 mm. The mean MWS for both groups was 6 mm. Concentration of positive skin test in those patients without SR varied from prick (1:1000 w/v) to intradermal at 1:1,000 w/v, while in all 3 patients with SR concentration was intradermal at 1:1,000,000 w/v. MWS and concentration of positive skin test were not significantly different between patients with and without SR. CONCLUSIONS: MWS and concentration at positive with IFAWBE skin testing were not correlated with increased risk for systemic reaction in our patient cohort.
113
Field Experiments On Foraging Hymenoptera Do Not Support Recommendations Against Wearing Perfume Or Bright, Floral-patterned Clothing J. C. Carlson, M. S. Fox; Tulane University, New Orleans, LA. RATIONALE: Recommendations given to venom-sensitive patients for avoiding contact with foraging Hymenoptera include eschewing perfumes and bright or floral-patterned clothing. These recommendations are based on theoretical concerns, and are in contrast to the recommendations made by bee keepers and other entomologists on clothing colors to avoid. METHODS: A controlled field trial was conducted using 100 assessments in a factorial design to assess the influence of visual cues (bright, floral pattern vs. dark, no pattern) and olfactory cues (presence vs. absence of perfume) on the propensity of foraging Hymenoptera to alight upon clothing. Experimental treatment combinations were observed at sites with high and low foraging activity. RESULTS: Foraging Hymenoptera rarely touched clothing of any type (7 of 100 assessments) even with high foraging activity in adjacent control plots (up to 20 honeybees/min). Although not statistically significant, Hymenoptera tended to contact dark clothing (Fisher’s exact P 5 0.44) and clothing without perfume (P 5 0.11). Among social insect species, only a single honey bee and paper wasp made contact with clothing. CONCLUSIONS: This study fails to support current recommendations discouraging use of perfume or bright, floral-patterned clothing in patients with hypersensitivity to Hymenoptera venom. Discrepancies between human and insect senses of vision and olfaction almost certainly account for these results. Perfumes may even be repellent to insects seeking specific plant-derived odors, as most scents in perfumes are synthetic. Further evaluations should empirically investigate recommendations made by entomologists to avoid dark clothing due to a theoretical risk of being targeted by colony defenders when a nearby hive has been disturbed.
114
Allergy to Hymenoptera Venom and HLA Class II Association P. Kucera1,2, M. Cerna1, K. Hulikova1, M. Cvackova1,2; 13rd Faculty od Medicine, Charles University, Prague 10, CZECH REPUBLIC, 2 Univ Hosp KV, Prague, CZECH REPUBLIC. RATIONALE: We analyzed the polymorphism of HLA alleles in patients with allergy to bee or wasp venom. METHODS: 107 unrelated patients with systemic hypersensitivity reaction due to allergy venom were evaluated. A HLA DR and DQ genes were typed using PCR with sequence specific primers, specific IgE and serum tryptase was measured. RESULTS: In venom allergic patients, the DRB1*01 allele tended to be more frequent than in normal matched population, but without statistical significance (25.5% versus 17.1%, p 5 0.138). In patients, grouped according the reaction severity, the frequency of DRB1*04 allele was significantly higher in patients with more severe form of anaphylaxis (50% in group with more severe reaction, this allele was absent in groups with less severe reaction, p 5 0.028). Also HLA DRB1*14 allele frequency was higher in patients with more severe reaction. The frequency of DR1*07 was significantly associated with reactivity to bee venom, in comparison with allergy to wasp venom (64.3% and 35.7% respectively, p 5 0.013). The significance is even more pronounced, when sex and age of patients was analyzed. We did not find the level of IgE specific to allergen nor basal tryptase value to be dependent on specific allele frequency. CONCLUSIONS: Our results indicate the severity of hypersenzitivity reaction is significantly associated with the presence of susceptible HLA Class II alleles but not the presence of immune hypersensitivity to venom allergens. The HLA Class II association is more prominent in bee venom allergy than in wasp venom one.
115
The Prevalence Of Tyrophagus Putrescentiae Hypersensitivity In Subjects Over 70 Years Of Age In A VeteransÕ Nursing Home In Taiwan J. Tsai, E. Liao; Veterans General Hospital, Taichung, Taichung, TAIWAN. RATIONALE: Reports have shown a high prevalence of Tyrophagus putrescentiae (Tp) sensitization and its importance and clinical relevance in elderly subjects has grown rapidly. To investigate the prevalence of Tp-sensitization in elderly subjects in a veteransÕ nursing home using native and recombinant allergens. METHODS: A total of 199 subjects were enrolled in this study, 112 elderly subjects from a nursing home and 87 healthy young adults from the hospital staff as controls. The prevalence of Tp-hypersensitivity was determined by specific IgE measurements and basophil histamine release. Immunoblotting with or without inhibition with Dermatophagoides pteronyssinus (Dp) was performed to identify the major allergens and speciesspecific allergen to Tp. RESULTS: There were 39.3% (44/112) of the elderly population been sensitized to Tp and 17.9% (20/112) to Tp alone. There was a significantly higher prevalence of Tp-hypersensitivity in elderly subjects in comparison with the young adult population. In the age-association study of Tp and Dp sensitization, the elderly subjects were more sensitized to Tp than to Dp (p 5 0.02). The elderly subjects with chronic obstructive pulmonary disease (COPD) were 45.8% (11/24) Tp-sensitive. The major allergens, Tyr p2 and Tyr p3, were identified with molecular weights of 16 kDa (53%) and 26 kDa (50%) as determined by ELISA and immunoblot inhibition analyses. CONCLUSIONS: The prevalence of Tp sensitization was higher in elderly subjects, especially in patients with COPD. The high percentage of IgE-binding components to the allergens Tyr p2 and Tyr p3 indicated that both allergens may play a role in the pathogenesis of IgE-mediated allergic diseases in elderly populations.
SATURDAY
Abstracts AB29
J ALLERGY CLIN IMMUNOL VOLUME 125, NUMBER 2
Mean Wheal Size and Concentration at Positive as Risk Factors for Systemic Reaction with Imported Fire Ant Whole Body Extract Immunotherapy J. J. Sacha, E. Reyes; Wilford Hall Medical Center, San Antonio, TX. RATIONALE: To determine if initial skin test mean wheal size (MWS) or concentration at which test was positive are predictive of increased risk for future systemic reactions with imported fire ant (IFA) whole body extract (WBE) immunotherapy which could allow physicians to modify immunotherapy treatment schedules to limit risk and for more accurate risk management communication to patients when discussing IFA immunotherapy. METHODS: We reviewed retrospective data from patients receiving exclusively IFA WBE immunotherapy in an existing electronic medical database to determine the incidence of systemic reactions (SR) in this population, their initial positive skin test MWS, and the extract concentration at which the patient’s test was positive. Unpaired t test was utilized to determine if MWS with initial skin test or concentration at which the skin test was positive were predictive of future SR. RESULTS: Eighty-one patients met inclusion criteria, with 3 patients experiencing SR. MWS ranged from 3 to 17.5 mm in those patients without SR, while in those patients with SR MWS ranged from 5 to 6 mm. The mean MWS for both groups was 6 mm. Concentration of positive skin test in those patients without SR varied from prick (1:1000 w/v) to intradermal at 1:1,000 w/v, while in all 3 patients with SR concentration was intradermal at 1:1,000,000 w/v. MWS and concentration of positive skin test were not significantly different between patients with and without SR. CONCLUSIONS: MWS and concentration at positive with IFAWBE skin testing were not correlated with increased risk for systemic reaction in our patient cohort.
113
Field Experiments On Foraging Hymenoptera Do Not Support Recommendations Against Wearing Perfume Or Bright, Floral-patterned Clothing J. C. Carlson, M. S. Fox; Tulane University, New Orleans, LA. RATIONALE: Recommendations given to venom-sensitive patients for avoiding contact with foraging Hymenoptera include eschewing perfumes and bright or floral-patterned clothing. These recommendations are based on theoretical concerns, and are in contrast to the recommendations made by bee keepers and other entomologists on clothing colors to avoid. METHODS: A controlled field trial was conducted using 100 assessments in a factorial design to assess the influence of visual cues (bright, floral pattern vs. dark, no pattern) and olfactory cues (presence vs. absence of perfume) on the propensity of foraging Hymenoptera to alight upon clothing. Experimental treatment combinations were observed at sites with high and low foraging activity. RESULTS: Foraging Hymenoptera rarely touched clothing of any type (7 of 100 assessments) even with high foraging activity in adjacent control plots (up to 20 honeybees/min). Although not statistically significant, Hymenoptera tended to contact dark clothing (Fisher’s exact P 5 0.44) and clothing without perfume (P 5 0.11). Among social insect species, only a single honey bee and paper wasp made contact with clothing. CONCLUSIONS: This study fails to support current recommendations discouraging use of perfume or bright, floral-patterned clothing in patients with hypersensitivity to Hymenoptera venom. Discrepancies between human and insect senses of vision and olfaction almost certainly account for these results. Perfumes may even be repellent to insects seeking specific plant-derived odors, as most scents in perfumes are synthetic. Further evaluations should empirically investigate recommendations made by entomologists to avoid dark clothing due to a theoretical risk of being targeted by colony defenders when a nearby hive has been disturbed.
114
Allergy to Hymenoptera Venom and HLA Class II Association P. Kucera1,2, M. Cerna1, K. Hulikova1, M. Cvackova1,2; 13rd Faculty od Medicine, Charles University, Prague 10, CZECH REPUBLIC, 2 Univ Hosp KV, Prague, CZECH REPUBLIC. RATIONALE: We analyzed the polymorphism of HLA alleles in patients with allergy to bee or wasp venom. METHODS: 107 unrelated patients with systemic hypersensitivity reaction due to allergy venom were evaluated. A HLA DR and DQ genes were typed using PCR with sequence specific primers, specific IgE and serum tryptase was measured. RESULTS: In venom allergic patients, the DRB1*01 allele tended to be more frequent than in normal matched population, but without statistical significance (25.5% versus 17.1%, p 5 0.138). In patients, grouped according the reaction severity, the frequency of DRB1*04 allele was significantly higher in patients with more severe form of anaphylaxis (50% in group with more severe reaction, this allele was absent in groups with less severe reaction, p 5 0.028). Also HLA DRB1*14 allele frequency was higher in patients with more severe reaction. The frequency of DR1*07 was significantly associated with reactivity to bee venom, in comparison with allergy to wasp venom (64.3% and 35.7% respectively, p 5 0.013). The significance is even more pronounced, when sex and age of patients was analyzed. We did not find the level of IgE specific to allergen nor basal tryptase value to be dependent on specific allele frequency. CONCLUSIONS: Our results indicate the severity of hypersenzitivity reaction is significantly associated with the presence of susceptible HLA Class II alleles but not the presence of immune hypersensitivity to venom allergens. The HLA Class II association is more prominent in bee venom allergy than in wasp venom one.
115
The Prevalence Of Tyrophagus Putrescentiae Hypersensitivity In Subjects Over 70 Years Of Age In A VeteransÕ Nursing Home In Taiwan J. Tsai, E. Liao; Veterans General Hospital, Taichung, Taichung, TAIWAN. RATIONALE: Reports have shown a high prevalence of Tyrophagus putrescentiae (Tp) sensitization and its importance and clinical relevance in elderly subjects has grown rapidly. To investigate the prevalence of Tp-sensitization in elderly subjects in a veteransÕ nursing home using native and recombinant allergens. METHODS: A total of 199 subjects were enrolled in this study, 112 elderly subjects from a nursing home and 87 healthy young adults from the hospital staff as controls. The prevalence of Tp-hypersensitivity was determined by specific IgE measurements and basophil histamine release. Immunoblotting with or without inhibition with Dermatophagoides pteronyssinus (Dp) was performed to identify the major allergens and speciesspecific allergen to Tp. RESULTS: There were 39.3% (44/112) of the elderly population been sensitized to Tp and 17.9% (20/112) to Tp alone. There was a significantly higher prevalence of Tp-hypersensitivity in elderly subjects in comparison with the young adult population. In the age-association study of Tp and Dp sensitization, the elderly subjects were more sensitized to Tp than to Dp (p 5 0.02). The elderly subjects with chronic obstructive pulmonary disease (COPD) were 45.8% (11/24) Tp-sensitive. The major allergens, Tyr p2 and Tyr p3, were identified with molecular weights of 16 kDa (53%) and 26 kDa (50%) as determined by ELISA and immunoblot inhibition analyses. CONCLUSIONS: The prevalence of Tp sensitization was higher in elderly subjects, especially in patients with COPD. The high percentage of IgE-binding components to the allergens Tyr p2 and Tyr p3 indicated that both allergens may play a role in the pathogenesis of IgE-mediated allergic diseases in elderly populations.
SATURDAY
Abstracts AB29
J ALLERGY CLIN IMMUNOL VOLUME 125, NUMBER 2