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Long-Term Effectiveness of Venom Immunotherapy (VIT)
S308 Abstracts
Epidemiology of Hymenoptera Stings and Allergic Reactions in 10,000 Midschoolchildren- Results From a National Study Y. Graif1, O. Romano-Zelekha2, m. S. Green2, T. shohat3; 1allergy and immunology clinic,Pulmonary institute, Rabin Medical Center, PetachTiqva, ISRAEL, 2Israel center of disease control, Israel Ministry of Health, Tel-hashomer, ISRAEL, 3Tel-Aviv health district, Israel Ministry of Health, Tel-aviv, ISRAEL. RATIONALE: The epidemiology of Hymenoptera stings and allergic reactions varies in different studies. We investigated the prevalence of stings and allergic reactions in mid schoolchildren across Israel. METHODS: A modified version of the International Study of Asthma and Allergies in Childhood written questionnaire was administered to a national sample of 13-14 yr-old schoolchildren, across Israel. Questions regarding Hymenoptera stings, allergic reactions, and hospital attendance were added. The questionnaire was filled by the children themselves. The parents of the children received an explanatory letter with a reply slip that served as an informed consent. RESULTS: There were 10,021 complete questionnaires available for analysis. 5,644 children (56.3%) were stung at least once in their lifetime, 60% of them were stung more than once. Boys, Arab children, and rural residents were stung significantly more often (p<0.0001). 11.5% of the children reported having had large local reaction (LLR), 6.5% mild (cutaneous) systemic reaction (MSR) and 2.5% had moderate to severe systemic reaction (SSR). After adjustment for various potential risk factors, having been stung more than once and Arab population group, were significant risk factors for LLR, MSR,and SSR. LLR was strongly associated with SSR (OR 6.26, 95% CI, 4.66-8.41) and with MSR (OR 5.15, 95% CI, 4.24-6.25). CONCLUSIONS: The prevalence of stings is high among schoolchildren in Israel. More stings associated with more allergic reactions. Systemic reactions were reported higher than previously described in children and were associated with LLR. Arab children have more allergic reactions from all kinds, independent of the number of stings.
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Long-Term Effectiveness of Venom Immunotherapy (VIT)
TUESDAY
T. Hafner, M. Kosnik; University Clinic of Respiratory and Allergic Diseases, Golnik, SLOVENIA. RATIONALE: This survey assesses the duration of efficacy and dynamics of reactions in patients with repeated stings who had finished VIT between 1988 and 2004. METHODS: A mail inquiry was sent to assess whether the patients were stung after VIT and all patients were contacted by telephone who were stung and had any reaction. Patients subjectively compared the severity of reactions before and after treatment with VIT. RESULTS: 229 patients responded, a rate of 70%. The VIT duration on average was 4.16 years. 181 (79%) patients were treated more than 3 years. 100 (55%) were stung after VIT by the same insect. At the first sting 92 (92%) had a local reaction and 8 (8%) had a systemic reaction. 40 (52%) patients were stung more than once. In 8 (20%) subsequent reactions were more severe than the first one, occurring 2 to 7 years after the first sting. All patients stated that reactions after VIT were milder than reactions before VIT. CONCLUSIONS: VIT provides long-term protection to most patients who were previously allergic to insect stings, a small minority of patients having worse reactions after repeated insect stings. Duration of VIT was not prognostic for long-term success. Funding: Univ Clin of Respiratory and Allergic Diseases
J ALLERGY CLIN IMMUNOL FEBRUARY 2006
Identification of the Major Allergens of the Venom from the South American Social Wasp Agelaia Pallipes C. E. S. Galvao1, L. K. Iwai2, L. D. Santos3, M. A. Mendes3, M. S. Palma3, F. F. M. Castro1, E. Cunha Neto2, J. Kalil1,2; 1Clinical Immunology and Allergy, University of Sao Paulo Medical School, Sao Paulo, BRAZIL, 2Laboratory of Immunology - Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, BRAZIL, 3Biology Department, Institute of Biosciences, Center of Study of Social Insects, Sao Paulo State University - UNESP, Rio Claro, BRAZIL. RATIONALE: A significant number of patients allergic to South American vespid venoms fail to display specific IgE towards commercially diagnostic wasp allergen extracts. We sought to identify the major allergens from the venom of the social wasp Agelaia pallipes pallipes using the proteomic analysis approach, searching for novel, non-crossreactive allergens. METHODS: The venom was submitted to bidimensional electrophoresis with immobilized pH gradient strips (pH 3.0 -10.0) for the first dimension and 15% SDS-PAGE for the second dimension. Gels were made in duplicate; the proteins were transferred to a nitrocellulose membrane and incubated with sera from three A. pallipes-sensitized patients. Immunoblot detection was performed with biotinylated anti-human IgE and Enhanced chemiluminescence. Protein spots recognized by specific IgE were identified in paired gels by Peptide Mass Fingerprinting (PMF) with the aid of a MALDI-ToF mass spectrometer and a protein engine database search tool. RESULTS: Although most protein spots in A. pallipes venom were below 20 kDa, only proteins in the 20 - 38 kDa range were recognized by IgE. Five consistent protein spots were recognized by specific IgE in immunoblotting assays with sera from the three patients. The major antigenic proteins were identified as Antigen 5 and serine-proteases. CONCLUSIONS: This is the first study to identify the major allergens from the venom of a neotropical vespid venom using proteomic analysis. Allergens were identified as Antigen 5 and serine-proteases. These proteases also presented with partial similarity with those from vertebrates (snake) venoms. The next step of this study will be the sequencing of these proteins. Funding: São Paulo State Science Funding Agency (FAPESP)
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Predictive Value of Sting Challenge
D. Kelly1, T. Grace1, D. B. K. Golden1, T. Craig2, N. Breisch3, R. G. Hamilton1; 1Johns Hopkins University, Baltimore, MD, 2Penn State Hershey Medical Center, Hershey, PA, 3University of Maryland, College Park, MD. RATIONALE: One sting challenge (SC) with no systemic reaction (SR) can still be followed by SR to a second SC in 15-20% cases. Our aim was to determine the outcome of stings occurring in the field (FS) in the years after SC was performed. METHODS: SC was performed in 233 patients between 1997-2004. During the study we inquire annually about the details of any FS. We recently surveyed all patients for information on FS that occurred after the initial SC. RESULTS: The overall frequency of systemic reactions to the SC was 69/233 patients (30%). Reaction occurred on initial SC in 52/233 (22%), and on second SC in 17 of 86 initial non-reactors (20%). Information on FS was available for 116 patients: 30 had had a SR to the SC (reactors) and 86 had not (non-reactors). Among the reactors, 10 reported FS and 3 (30%) had a SR. Among the non-reactors, 28 reported FS and 1 (3.5%) had a SR. Of these 28, 15 had had one SC and 13 had >=2 SC. The reaction rate was significantly greater in the SC reactors (p < 0.01). CONCLUSIONS: Patients who did not react to SC had a low risk of reaction to FS, but sequential (same-summer) stings may still cause a reaction. Reactions still may occur with a second SC with a known insect. Those who do react to SC continue to have the same 30% risk of reaction to FS. Funding: NIH
Epidemiology of Hymenoptera Stings and Allergic Reactions in 10,000 Midschoolchildren- Results From a National Study Y. Graif1, O. Romano-Zelekha2, m. S. Green2, T. shohat3; 1allergy and immunology clinic,Pulmonary institute, Rabin Medical Center, PetachTiqva, ISRAEL, 2Israel center of disease control, Israel Ministry of Health, Tel-hashomer, ISRAEL, 3Tel-Aviv health district, Israel Ministry of Health, Tel-aviv, ISRAEL. RATIONALE: The epidemiology of Hymenoptera stings and allergic reactions varies in different studies. We investigated the prevalence of stings and allergic reactions in mid schoolchildren across Israel. METHODS: A modified version of the International Study of Asthma and Allergies in Childhood written questionnaire was administered to a national sample of 13-14 yr-old schoolchildren, across Israel. Questions regarding Hymenoptera stings, allergic reactions, and hospital attendance were added. The questionnaire was filled by the children themselves. The parents of the children received an explanatory letter with a reply slip that served as an informed consent. RESULTS: There were 10,021 complete questionnaires available for analysis. 5,644 children (56.3%) were stung at least once in their lifetime, 60% of them were stung more than once. Boys, Arab children, and rural residents were stung significantly more often (p<0.0001). 11.5% of the children reported having had large local reaction (LLR), 6.5% mild (cutaneous) systemic reaction (MSR) and 2.5% had moderate to severe systemic reaction (SSR). After adjustment for various potential risk factors, having been stung more than once and Arab population group, were significant risk factors for LLR, MSR,and SSR. LLR was strongly associated with SSR (OR 6.26, 95% CI, 4.66-8.41) and with MSR (OR 5.15, 95% CI, 4.24-6.25). CONCLUSIONS: The prevalence of stings is high among schoolchildren in Israel. More stings associated with more allergic reactions. Systemic reactions were reported higher than previously described in children and were associated with LLR. Arab children have more allergic reactions from all kinds, independent of the number of stings.
1187
1188
Long-Term Effectiveness of Venom Immunotherapy (VIT)
TUESDAY
T. Hafner, M. Kosnik; University Clinic of Respiratory and Allergic Diseases, Golnik, SLOVENIA. RATIONALE: This survey assesses the duration of efficacy and dynamics of reactions in patients with repeated stings who had finished VIT between 1988 and 2004. METHODS: A mail inquiry was sent to assess whether the patients were stung after VIT and all patients were contacted by telephone who were stung and had any reaction. Patients subjectively compared the severity of reactions before and after treatment with VIT. RESULTS: 229 patients responded, a rate of 70%. The VIT duration on average was 4.16 years. 181 (79%) patients were treated more than 3 years. 100 (55%) were stung after VIT by the same insect. At the first sting 92 (92%) had a local reaction and 8 (8%) had a systemic reaction. 40 (52%) patients were stung more than once. In 8 (20%) subsequent reactions were more severe than the first one, occurring 2 to 7 years after the first sting. All patients stated that reactions after VIT were milder than reactions before VIT. CONCLUSIONS: VIT provides long-term protection to most patients who were previously allergic to insect stings, a small minority of patients having worse reactions after repeated insect stings. Duration of VIT was not prognostic for long-term success. Funding: Univ Clin of Respiratory and Allergic Diseases
J ALLERGY CLIN IMMUNOL FEBRUARY 2006
Identification of the Major Allergens of the Venom from the South American Social Wasp Agelaia Pallipes C. E. S. Galvao1, L. K. Iwai2, L. D. Santos3, M. A. Mendes3, M. S. Palma3, F. F. M. Castro1, E. Cunha Neto2, J. Kalil1,2; 1Clinical Immunology and Allergy, University of Sao Paulo Medical School, Sao Paulo, BRAZIL, 2Laboratory of Immunology - Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, BRAZIL, 3Biology Department, Institute of Biosciences, Center of Study of Social Insects, Sao Paulo State University - UNESP, Rio Claro, BRAZIL. RATIONALE: A significant number of patients allergic to South American vespid venoms fail to display specific IgE towards commercially diagnostic wasp allergen extracts. We sought to identify the major allergens from the venom of the social wasp Agelaia pallipes pallipes using the proteomic analysis approach, searching for novel, non-crossreactive allergens. METHODS: The venom was submitted to bidimensional electrophoresis with immobilized pH gradient strips (pH 3.0 -10.0) for the first dimension and 15% SDS-PAGE for the second dimension. Gels were made in duplicate; the proteins were transferred to a nitrocellulose membrane and incubated with sera from three A. pallipes-sensitized patients. Immunoblot detection was performed with biotinylated anti-human IgE and Enhanced chemiluminescence. Protein spots recognized by specific IgE were identified in paired gels by Peptide Mass Fingerprinting (PMF) with the aid of a MALDI-ToF mass spectrometer and a protein engine database search tool. RESULTS: Although most protein spots in A. pallipes venom were below 20 kDa, only proteins in the 20 - 38 kDa range were recognized by IgE. Five consistent protein spots were recognized by specific IgE in immunoblotting assays with sera from the three patients. The major antigenic proteins were identified as Antigen 5 and serine-proteases. CONCLUSIONS: This is the first study to identify the major allergens from the venom of a neotropical vespid venom using proteomic analysis. Allergens were identified as Antigen 5 and serine-proteases. These proteases also presented with partial similarity with those from vertebrates (snake) venoms. The next step of this study will be the sequencing of these proteins. Funding: São Paulo State Science Funding Agency (FAPESP)
1189
1190
Predictive Value of Sting Challenge
D. Kelly1, T. Grace1, D. B. K. Golden1, T. Craig2, N. Breisch3, R. G. Hamilton1; 1Johns Hopkins University, Baltimore, MD, 2Penn State Hershey Medical Center, Hershey, PA, 3University of Maryland, College Park, MD. RATIONALE: One sting challenge (SC) with no systemic reaction (SR) can still be followed by SR to a second SC in 15-20% cases. Our aim was to determine the outcome of stings occurring in the field (FS) in the years after SC was performed. METHODS: SC was performed in 233 patients between 1997-2004. During the study we inquire annually about the details of any FS. We recently surveyed all patients for information on FS that occurred after the initial SC. RESULTS: The overall frequency of systemic reactions to the SC was 69/233 patients (30%). Reaction occurred on initial SC in 52/233 (22%), and on second SC in 17 of 86 initial non-reactors (20%). Information on FS was available for 116 patients: 30 had had a SR to the SC (reactors) and 86 had not (non-reactors). Among the reactors, 10 reported FS and 3 (30%) had a SR. Among the non-reactors, 28 reported FS and 1 (3.5%) had a SR. Of these 28, 15 had had one SC and 13 had >=2 SC. The reaction rate was significantly greater in the SC reactors (p < 0.01). CONCLUSIONS: Patients who did not react to SC had a low risk of reaction to FS, but sequential (same-summer) stings may still cause a reaction. Reactions still may occur with a second SC with a known insect. Those who do react to SC continue to have the same 30% risk of reaction to FS. Funding: NIH