88 Clinical Features and Diagnostic Value of Specific IGE to Component Allergen in Bee Venom Allergy in Korea

BACKGROUND: Although history taking is primary method in the diagnosis of bee venom allergy, serum specific IgE detection is critical to identify causative bee and assess the effect of immunotherapy. Component-resolved diagnosis (CRD) in allergy has been used for its high sensitivity and specificity in many allergy diseases caused by food, cat, birch, and grass pollens. The purposes of this study are to evaluate diagnostic value of serum specific IgE to 3 bee venom component allergens and observe the changes of allergen specific IgE during bee venom immunotherapy. METHODS: Fifty-six bee venom anaphylaxis patients receiving bee venom immunotherapy were recruited from Ajou University Hospital. Clinical manifestations and serum specific IgE levels to bee venoms and component allergen (rApi m1 of Apidae, rVes v5 and rPol d5 of Vespidae) measured by using ImmunoCAP (Phadia, Sweden) were analyzed retrospectively. RESULTS: Thirty-five (62.5%) patients were male and 33 (73.3%) were atopics. Their mean age was 44.9 ± 13.8 years ranged from 11 to 73 years. Local reactions were found in 13 (23.2%) patients, while systemic reactions, in 43 (76.8%) patients. The most frequent manifestation was anaphylaxis which were severe (37.5%) and moderate (39.3%) manifestations followed by urticaria and angioedema. Yellow Jacket (80.8%) was the most prevalent bee followed by yellow hornet, white faced hornet, honey bee and paper wasp at the time of diagnosis with concurrent sensitization in both Apidae and Vespidae at 70.9% patients. The positive predictive value (PPV) of serum specific IgE levels to rVes v5 and rPol d5 were 85.7 and 87.5%, and they significantly correlated with conventional serum specific IgE level (r = 0.762 and r = 0.757, respectively), however, PPV of rApi m1 was only 34.8% at the time of initial diagnosis. After 3 years of bee venom immunotherapy, all kinds of bee venom specific IgE levels tended to decline compared to those collected before allergen immunotherapy, especially in component specific IgE to Vespidae. CONCLUSIONS: Yellow jacket sting and male gender may be risk factors for bee venom allergy in Korea. Component allergen specific IgE to Vespidae, not Apidae had a diagnostic and monitoring value comparable to conventional specific IgE in bee venom allergy.