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

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• 作者：Marcel Frick ; MS^a ; ^b ; ^&lowast ; ; Jö ; rg Fischer ; MD^c ; ^&lowast ; ; Arthur Helbling ; MD^d ; Franziska Ruë ; ff ; MD^e ; Dorothea Wieczorek ; MD^f ; Markus Ollert ; MD^g ; ^h ; Wolfgang Pfü ; tzner ; MDⁱ ; Sabine Mü ; ller ; MD^b ; Johannes Huss-Marp ; MD ; MBA^b ; Britta Dorn^a ; ^b ; Tilo Biedermann ; MD^c ; ^j ; Jonas Lidholm ; PhD^k ; Gerta Ruecker ; PhD^l ; Frank Bantleon ; PhD^m ; Michaela Miehe ; PhD^m ; Edzard Spillner ; PhD^m ; ^&Dagger ; ; Thilo Jakob ; MD^a ; ^b ; ^&Dagger ; ; ^{thilo.jakob@derma.med.uni-giessen.de}
• 关键词：Apis mellifera ; Hymenoptera venom allergy ; HBV allergy ; recombinant allergen ; allergen-specific immunotherapy ; treatment failure
• 刊名：Journal of Allergy and Clinical Immunology
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：138
• 期：6
• 页码：1663-1671.e9
• 全文大小：1342 K
• 卷排序：138

文摘

Component resolution recently identified distinct sensitization profiles in honey bee venom (HBV) allergy, some of which were dominated by specific IgE to Api m 3 and/or Api m 10, which have been reported to be underrepresented in therapeutic HBV preparations.ObjectiveWe performed a retrospective analysis of component-resolved sensitization profiles in HBV-allergic patients and association with treatment outcome.MethodsHBV-allergic patients who had undergone controlled honey bee 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) on the basis of absence or presence of systemic allergic reactions upon sting challenge. IgE reactivity to a panel of HBV allergens was analyzed in sera obtained before immunotherapy and before sting challenge.ResultsNo differences were observed between responders and nonresponders regarding levels of IgE sensitization to Api m 1, Api m 2, Api m 3, and Api m 5. In contrast, Api m 10 specific IgE was moderately but significantly increased in nonresponders. Predominant Api m 10 sensitization (>50% of specific IgE to HBV) was the best discriminator (specificity, 95%; sensitivity, 25%) with an odds ratio of 8.444 (2.127-33.53; P = .0013) for treatment failure. Some but not all therapeutic HBV preparations displayed a lack of Api m 10, whereas 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 observed only in those patients who were treated with HBV in which Api m 10 was detectable.ConclusionsComponent-resolved sensitization profiles in HBV allergy suggest predominant IgE sensitization to Api m 10 as a risk factor for treatment failure in HBV immunotherapy.