Abstract：
Background: Hymenoptera venom allergy (HVA) is among the most common causes of severe allergic reactions worldwide. Objective: To investigate clinical features and factors that affect the severity of HVA and to determine the alterations in immunologic biomarkers after venom immunotherapy (VIT). Methods: Seventy-six adults and 36 children were prospectively investigated. We analyzed specific immunoglobulin E (sIgE) and sIgG4 levels of venom extracts and components (rApi m1, rApi m10, rVes v1, rVes v5, rPol d5) before and after the first year of VIT. Results: Although cardiovascular symptoms were more common in adults (p < 0.001), the skin was the most affected organ in children (p = 0.009). Serum basal tryptase (sBT) levels were higher in the adults than the children (p < 0.001). The absence of urticaria (odds ratio [OR] 4.208 [95% confidence interval {CI}, 1.395-12.688]; p = 0.011) and sBT ≥ 5.2 ng/mL (OR 11.941 [95% CI, 5.220-39.733]; p < 0.001) were found as the risk factors for grade IV reactions. During VIT, changes in sIgE levels were variable. In the Apis VIT group, we observed remarkable increases in sIgG4 levels in Apis extract and rApi m1 but not in Api m10. Vespula extract, rVes v1, and rVes v5 sIgG4 levels were significantly increased in Vespula VIT group, we also detected significant increases in the Polistes extract and rPol d5 sIgG4 levels, which were not observed in the Apis VIT group. In the patients who received both Apis and Vespula VIT, increases in sIgG4 levels were observed for both venoms. Conclusion: Adults and children can have different clinical patterns. After 1 year, VIT induced a strong IgG4 response. Although Apis immunotherapy (IT) induced Apis sIgG4, excluding Api m10, Vespula IT induced both Vespula and Polistes sIgG4.
摘要：
背景：膜翅目毒液过敏（HVA）是全球严重过敏反应的最常见原因之一。目的：探讨毒液免疫治疗（VIT）后HVA的临床特征和影响严重程度的因素，并确定免疫标志物的变化。方法：对76名成人和36名儿童进行前瞻性调查。我们分析了VIT第一年前后毒液提取物和成分（rApim1，rApim10，rVesv1，rVesv5，rPold5）的特异性免疫球蛋白E（sIgE）和sIgG4水平。结果：尽管心血管症状在成人中更为常见（p<0.001），皮肤是儿童受影响最大的器官(p=0.009)。成人血清基础类胰蛋白酶（sBT）水平高于儿童（p<0.001）。没有荨麻疹（比值比[OR]4.208[95%置信区间{CI}，1.395-12.688]；p=0.011）和sBT≥5.2ng/mL（OR11.941[95％CI，5.220-39.733]；p<0.001）被发现是IV级反应的危险因素。在VIT期间，sIgE水平的变化是可变的。在ApisVIT组中，我们观察到Apis提取物和rApim1中sIgG4水平显着增加，但Apim10中没有。维苏拉提取物，VespulaVIT组rVesv1和rVesv5sIgG4水平显著升高,我们还检测到Polistes提取物和rPold5sIgG4水平的显着增加，在ApisVIT组中未观察到。在同时接受Apis和VespulaVIT的患者中，观察到两种毒液的sIgG4水平升高。结论：成人和儿童可以有不同的临床表现。一年后，VIT诱导强烈的IgG4应答。尽管Apis免疫疗法（IT）诱导了ApissIgG4，但不包括Apim10，VespulaIT诱导了Vespula和PolistessIgG4。
