Evaluation von Messinstrumenten bei der allergologischen Diagnostik vor und während einer spezifischen Immuntherapie mit Hymenopterengiftextrakt

Evaluation of measuring instruments in allergological diagnostics before and during specific immunotherapy with hymenopteran venom extract

by Lisa Lorbeer
Doctoral thesis
Date of Examination:2023-03-07
Date of issue:2023-03-07
Advisor:Prof. Dr. Timo Buhl
Referee:Prof. Dr. Christiane Lex
Referee:Prof. Dr. Ralf Dressel
Persistent Address: http://dx.doi.org/10.53846/goediss-9759

 

 

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Abstract

English

Allergies against Hymenoptera venoms are one of the most common causes of severe anaphylactic reactions, besides food and drug allergies. The diagnosis of suspected Hymenoptera venom allergy consists of patient history, serological parameters and skin tests. The risk for recurrent anaphylaxis in case of a new sting event cannot be determined by any biomarker. Up to now, parameters such as comorbidities, medication intake, and the initial degree of anaphylaxis have been known to provide a rough estimate of the likelihood of a recurrence of severe anaphylaxis. For risk minimization, there is the option of specific immunotherapy (SIT). Especially during therapy, the effectiveness is undisputed. In a retrospective study, we analyzed the serological parameters and the results of intracutaneous skin testing before and during SIT. At the beginning of SIT, elevated gift-specific IgE levels are typical. In our collective, this decreased significantly over years. In contrast, there was an increase in gift-specific IgG and IgG4 levels, which increased significantly during the first 48 months of SIT. Overall, in the time course of SIT in our collective, including all venom concentrations, no clear tendency for area reduction of urticae in the intracutaneous tests could be demonstrated. Nontheless, a revised guideline for diagnosis and therapy in hymenopteran venom allergic patients is needed. Despite all the evidence from the current literature, the establishment of a guideline will continue to be difficult in the future.
Keywords: intracutaneous test; allergy; insect venom allergy; specific IgE; specific immunotherapy
 
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