Venom, insect

Table 2. Prevalence of symptoms in anaphylactic reactions according to Przybilla and Rueff [see 18]. A meta-analysis of 1,865 cases from 14 publications (Liebermann) and 865 own patients with insect venom anaphylaxis... 

Another way to classify anaphylactic reactions regards the eliciting agents the most common elicitors of anaphylaxis are drugs, insect venoms, foods, additives,... 

Bonifazi F, Jutel M, Bilo BM. Bimbaum J. Muller U EAACI Interest Group on Insect Venom Hypersensitivity Prevention and treatment of Hymenoptera venom allergy guidelines for chnical practice. Allergy 2005 60 1459-1470. 

Anaphylaxis that is IgE-dependent is most commonly associated with reactions to foods, drugs, and insect venoms. Anaphylactic-like reactions that are not dependent... 

Diet should be modified only in cases where foods have been proven to elicit symptoms. Patients with mastocytosis and Hymenoptera venom exposure are at risk for severe anaphylaxis. Thus, specific immunotherapy should be considered in patients with Hymenoptera venom allergy and then administered under close supervision [31]. The majority of patients with mastocytosis reportedly tolerate immunotherapy without significant side effects and appear protected following this approach [33,40]. However, there does appear to be some increased risk for adverse reactions during initiation of immunotherapy, as well as for therapy failures [31, 33]. An increased maintenance dose of insect venom has been reported to carry better success rates by sting provocation [41]. Also, in the light of 2 fatal cases of anaphylaxis after discontinuation of SIT in patients with mastocytosis [30], lifelong immunotherapy should be considered [26]. 

In rare cases, initiation of specific immunotherapy with insect venom leads to recurrent anaphylaxis, even with antihistamine premedication. In those cases, comedication with omalizumab (anti-IgE) has been reported to induce tolerance. In a case of recurrent anaphylaxis to induction of specific immunotherapy, the injection of 300 mg of omalizumab between 4 days and 1 h reportedly led to tolerance [42]. This approach also appears worthy of consideration in patients with both idiopathic recurrent anaphylaxis and mastocytosis who do not respond to standard antimediator therapy, as has been described in 2 atopic patients with ISM [43]. Most patients with mastocytosis and idiopathic anaphylaxis, however, are sufficiently controlled by standard antimediator therapy with antihistamines with or without low-dose corticosteroids. 

Eberlein-Konig B. Rakoski J, Behrendt H, Ring J Use of CD63 expression as marker of in vitro basophil activation in identifying the culprit in insect venom allergy. J Investig Allergol Chn Immunol 2004 14 10-16. 

Insect venoms, together with foods and drugs, are the most frequent elicitors of anaphylaxis in men. The insect venom is applied by stings which must have occurred for more than 100,000 years, since human beings exist. Conflicts between stinging insects and humans occur while fighting for food, like honey or foods consumed outdoors, or while venomous insects feel threatened by human beings, most often near their nests. 

Golden DBK, Marsh DG, Kagey-Sobotka A, Freidhoff L, Szklo M, Valentine MD, Lichtenstein LM Epidemiology of insect venom sensitivity. JAMA 1989 262 240-244. 

Van der Linden PW, Hack CE, Struyvenberg A, van der Zwan JK Insect sting challenge in 324 subjects with a previous anaphylactic reaction current criteria for insect venom hypersensitivity do not predict the occurrence and severity of anaphylaxis. J Allergy Clin Immunol 1994 94 1512-1519. 

If possible, refer patient to allergen-specific immunotherapy (e.g. insect venom anaphylaxis)... 

Stumpf JL. Shehab N. Patel AC Safety of angiotensin-converting enzyme inhibitors in patients with insect venom allergies. Ann Pharmacother 2006 40 699-703. 

As outlined above, SIT, which has been shown to involve adaptive and natural Tregs in respiratory allergy and insect venom allergy [46], appears to work in atopic dermatitis as well. During SIT the... 

Bellinghausen I, Metz G, Enk AH, Christmann S, Knop J, Saloga J Insect venom immunotherapy induces interleukin-10 production and a Th2- to-Thl shift, and changes surface marker expression in venom-allergic subjects. Eur J Immunol 1997 27 1131-1139. 

M. S. Palma, Insect Venom Peptides. In Handbook of Biologically Active Peptides] J. Kastin, Ed. Elsevier Amsterdam, 2006 p 389. 

Some biochemical natural products have caused cardiotoxicity. Synthetic estrogens and progestins have been linked to cardiovascular disorders in women taking them for contraceptive purposes. Various animal and insect venoms and plant alkaloids may have adverse cardiovascular effects. There is some evidence to suggest that anabolic steroids, commonly linked to scandals involving athletes who take them to enhance performance, have caused cardiovascular disorders. 

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