Wasp venom

A prominently expressed gene family in many parasitic nematodes bears similarity to allergens present in vespid (e.g. wasp) venom. For example, the canine hookworm Ancylostoma caninum expresses high levels of this protein when larvae are activated to invade (Hawdon et al., 1996). Similar genes are found in B. malayi (R.M. Maizels and J. Murray, 1999,... 

Nasser SM, Ymg S, Meng 0, Kay AB, Ewan PW Interleukin-10 levels increase in cutaneous biopsies of patients undergoing wasp venom immunotherapy. Eur J Immunol 2001 31 3704-3713. 

Pierkes M, Bellinghausen I, Hultsch T, Metz G, Knop J, Saloga J Decreased release of histamine and sulfi-doleukotrienes by human peripheral blood leukocytes after wasp venom immunotherapy is partially due to induction of IL-10 and IFN- production of T cells. J Allergy Clin Immunol 1999 103 326-332. 

Aminomethyl-3-nitrobenzoylpolyethyleneglycols are another class of photosensitive soluble polymeric supports designed for the liquid phase synthesis of protected peptide amides 192,193) (scheme 8). These supports have been very recently used for efficient synthesis of three biologically active 14-peptideamides corresponding to the wasp venom peptides, mastoparan, mastoparan X and Polistes mastoparan 198). 

In 36 patients with a history of systemic reactions (grade III or IV according to Mueller) after exposure to a wasp sting, who were given immunotherapy with aluminium hydroxide-adsorbed wasp venom extract in an open retrospective study, a maintenance monthly depot of 50 000 SQU (50 micrograms) of venom was used (13). After the first year, the dose was injected every other month. Desensitization therapy was well tolerated. There were... 

The authors performed RAST inhibition to measure the relative potencies of the different venom extracts using the patient s serum as a source of IgE anti-venom. Although they initially suspected the new source of Polistes wasp venom, the relative potency tests showed greater variation in the honeybee venom. The IgG concentrations were consistent with this finding. This report emphasizes the care that must be taken with the preparation of each injection, especially when using a new batch of antigen. 

Serum sickness has been described as a result of immunotherapy for wasp venom hypersensitivity. The illness was severe and treatment with glucocorticoids and seven plasma exchanges was required to induce a remission. There were two further relapses requiring the same treatment before recovery (SEDA-22, 197). 

Harries, M.G., Kemeny, D.M., Youlten, L. etal. (1984). Skin and radioalleigosorbent tests in patients with sensitivity to bee and wasp venom. Clin. Allei 14, 407-412. 

Histamine release from mast cells can be caused by a wide variety of basic substances, including mediators such as substance P, bradykinin and venoms such as mastoparan (from wasp venom). It is thought that this interaction involving endogenous mediators is a normal part of pathophysiology involved, for instance, in the triple response in skin. It has been proposed that the non-receptor-... 

Hydroxy tryptamine is also an active constituent of many venoms, e.g., wasp venom (441) and toad venom (237, 883). 

The risk of an allergic reaction is rare. EpiPens are used by clients who are allergic to bee stings or wasp venom. 

There are a few case reports of severe anaphylactoid reactions in patients receiving ACE inhibitors during desensitisation with bee or wasp venom. Extra caution is required, and some surest temporarily withholding the ACE inhibitor before each venom injection. 

A report describes 2 cases of anaphylactoid reactions during wasp venom immunotherapy in patients taking enalapril. In one patient, generalised pruritus and severe hypotension occurred within a few minutes of the first venom injection. Desensitisation was achieved after the enalapril was stopped, and then the immunotherapy was maintained by diseontinuing the enalapril 24 hours before the monthly venom injection. However, on one oeeasion, when the enalapril had not been stopped, the patient expe-rieneed a severe anaphylactoid reaction 30 minutes after the venom injee-tion. In the other patient an anaphylactoid reaction occurred after the seeond dose of venom. The ACE inhibitor was replaced with nifedipine so that venom immunotherapy could be continued. ... 

In another report, a 43-year-old man who had been taking ACE inhibitors for 2 years (lisinopril 40 mg daily for the previous 5 months) had a hypotensive reaction to an insect sting. After skin testing, he received venom immunotherapy. About 4 months later, he had a severe anaphylactic reaction 5 minutes after being given a maintenance dose of wasp venom and mixed vespid venom. The ACE inhibitor was replaced with a calcium-channel blocker, and he subsequently tolerated full-strength venom immunotherapy injections. ... 

On the basis of these few reports, it cannot be said with certainty that an interaction occurs however, it is possible that ACE inhibitors could exacerbate the response to insect venom immunotherapy. Because of the potential severity of the reaction, extra caution should be taken in patients taking ACE inhibitors and undergoing desensitising treatment with Hy-menoptera (bee or wasp) venom. Some authors " and manufacturers advise temporarily withholding the ACE inhibitor before each desensitisation (24 hours was sufficient in one case), while others suggest temporary substitution of a different antihypertensive e.g. a calcium-channel blocker. Note that some evidence suggests that anaphylactic shock in patients taking beta blockers may be resistant to treatment with adrenaline (epinephrine), see Beta blockers + Inotropes and Vasopressors , p.848. Therefore beta bloekers are probably not a suitable alternative. 

Mandaratoxln. A wasp venom from Vespa manda-rina structurally related to mastoparan. 

Mastoparans. M. 1 C7oH 3,N 0,5, Mr 1478.93, colorless powder, a peptide from the wasp venom of Ves-pula lewisii M. X C73H,26N2oO,5S, Mr 1556.0 from Vespa xanthoptera with the structural formulae ... 

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