The Journal of Allergy and Clinical Immunology: In Practice
Review and Feature ArticleHymenoptera Venom Extracts in Clinical Practice
Section snippets
Background
Among the allergenic extracts in clinical use, Hymenoptera venoms (HVs) are unique in many ways. First, the primary allergens are measurable. Aeroallergen extracts are marketed with labeled potency represented as various defined units such as weight to volume (w/v), allergy units, or bioequivalent allergy units (all of which are American), or standardized quality (SQ) units, index of reactivity (IR) units, and others (in Europe). Venom extracts are the only allergen extracts whose potency is
Part 1: Clinical history
While gardening, a 26-year-old gravida 1, para 0, female at 26 weeks estimated gestational age was stung by a ground-dwelling bee. Within 3 to 5 minutes she experienced a general feeling of anxiety, throat fullness, and some mild hives. After taking diphenhydramine and not improving she went to the emergency room where she was given additional diphenhydramine and observed for a period of 90 minutes. She continued to do well and was discharged with no follow-up or other specific treatment. After
Additional considerations
This case illustrates several additional relevant situations in which the characteristics of HV may affect diagnosis and treatment. First, that the role of mast cell disease and its association with venom-allergic individuals have assumed new prominence in recent years. The relationship is discussed in more detailed elsewhere.28 However, renewed understanding was sufficient to prompt a change in clinical recommendation regarding the measurement of serum tryptase in venom-allergic individuals.12
Summary
Venom allergy is the prototypic model for the diagnosis and management of anaphylaxis. The initial exposure is generally obvious, the progress of reactions predictable, and diagnostic methods reliable and readily available. Unlike other causes of anaphylaxis, preventative treatment is highly effective and available. Treatment with VIT provides an important window into our understanding of the management strategy of immunotherapy. HVs are the prototypic standardized allergens and their
Acknowledgments
We thank Derek Constable, PhD (Technical Director, Jubilant HollisterStier Allergy Products Division), for providing details and guidance on the technical aspects of venom production. Additional background information on venom collection and production was provided by Greg Plunkett, PhD (ALK-Abello Inc).
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Wings and stings: Hymenoptera on vacation
2023, Annals of Allergy, Asthma and ImmunologyAllergen Immunotherapy Extract Shortages and Their Effects on Clinical Care: A Work Group Report of the AAAAI Immunotherapy, Allergen Standardization, and Allergy Diagnostics Committee
2022, Journal of Allergy and Clinical Immunology: In PracticeCitation Excerpt :After removal of duplicates and screening for relevance, 11 publications remained. Of these, 1 was an AAAAI/ACAAI joint task force report on venom extract shortage,17 4 discussed transitioning products during venom extract shortage,15,16,18,19 3 were perspective articles discussing potential effects of single venom extract supplier and related reimbursement issues,20-22 1 was a review of literature on venom immunotherapy (VIT),23 and 1 discussed restarting VIT after discontinuation due to a shortage.24 There was only 1 publication that discussed allergen extract supply besides venom extract in the context of commercial laboratory preparation of individual immunotherapy vials.25
Venom allergy evaluation, diagnosis, and treatment
2022, Allergic and Immunologic Diseases: A Practical Guide to the Evaluation, Diagnosis and Management of Allergic and Immunologic Diseases
Conflicts of interest: J. M. Tracy declares receiving honorarium from UptoDate. D. B. K. Golden declares Speaker Bureau honoraria from Genentech and Stallergenes; research support for clinical trials from Genentech and Stallergenes; and receiving royalties as an Editor for UptoDate.