Predominant Api m 10 sensitization as risk factor for treatment failure in honey bee venom immunotherapy

Publication date: Available online 24 May 2016
Source:Journal of Allergy and Clinical Immunology
Author(s): Marcel Frick, Jörg Fischer, Arthur Helbling, Franziska Ruëff, Dorothea Wieczorek, Markus Ollert, Wolfgang Pfützner, Sabine Müller, Johannes Huss-Marp, Britta Dorn, Tilo Biedermann, Jonas Lidholm, Gerta Ruecker, Frank Bantleon, Michaela Miehe, Edzard Spillner, Thilo Jakob
BackgroundComponent resolution recently identified distinct sensitization profiles in honey bee venom (HBV) allergy, some of which were dominated by sIgE to Api m 3 and/or Api m 10 that have been reported to be underrepresented in therapeutic HBV preparations.ObjectiveRetrospective analysis of component resolved sensitization profiles in HBV allergic patients and association with treatment outcome.MethodsHBV allergic patients that had undergone controlled HB sting challenge after at least 6 months of HBV immunotherapy (n=115) were included and classified as responder (n=79) or treatment failure (n=36) based on absence or presence of systemic allergic reactions upon sting challenge. IgE reactivity to a panel of HBV allergens was analyzed in sera obtained prior to immunotherapy and prior to sting challenge.ResultsNo differences were observed between responders and non-responders regarding levels of IgE sensitization to Api m 1, Api m 2, Api m 3, and Api m 5. In contrast, Api m 10 sIgE was moderately but significantly increased in non-responders. Predominant Api m 10 sensitization (>50% of sIgE to HBV) was the best discriminator (specificity 95%, sensitivity 25%) with an odds ratio of 8.444 (2.127–33.53; p=0.0013) for treatment failure. Some but not all therapeutic HBV preparations displayed a lack of Api m 10, while Api m 1 and Api m 3 immunoreactivity was comparable to that of crude HBV. In line with this, significant Api m 10 sIgG4 induction was only observed in patients treated with HBV in which Api m 10 was detectable.ConclusionComponent resolved sensitization profiles in HBV allergy suggest predominant IgE sensitization to Api m 10 as risk factor for treatment failure in HBV immunotherapy.

Graphical abstract

Teaser

Retrospective analysis in honey bee venom allergy identifies predominant sensitization to Api m 10 as a risk factor for treatment failure in immunotherapy. Biochemical analysis demonstrates scarcity of Api m 10 in some therapeutic venom preparations.


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