Should We Consider Venom Immunotherapy When Levels of specific IgE to Insect Venom is between 0.1 and 0.34?

IF 6.6 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice Pub Date : 2025-09-17 DOI:10.1016/j.jaip.2025.09.005

Taha Al-Shaikhly, David B K Golden, Timothy J Craig

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引用次数: 0

Abstract

Venom immunotherapy (VIT) improves quality of life and is potentially lifesaving in patients with anaphylactic reactions to stinging insect venom and evidence of IgE-mediated sensitization. Sensitization is defined as either a positive skin test to insect venom or serum venom-specific IgE level that is equal to or above 0.35 kU/L. With the advent of advanced diagnostics, levels of sensitization as low as 0.1 kU/L can be appreciated; however, the approach to patients with a low level of sensitization (defined as venom-specific IgE levels between 0.1 and 0.34 kU/L) remains debatable. Additionally, when considering VIT for selected patients with large local reactions or cutaneous systemic reactions, encountering low levels of sensitization can complicate the clinical decision. In this pro/con debate, we discuss whether patients who had an anaphylactic reaction, cutaneous systemic reaction, or large local reaction to insect venom should receive VIT when diagnostic evaluation only reveals sensitization between 0.1 and 0.34 kU/L and negative skin testing. The pro position is presented by Dr. Al-Shaikhly, while the con position is discussed by Dr Craig. Dr. Golden served as moderator and fact-checker. This review is not intended to address the medical legal aspects, rather to direct research and clinical studies.

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当对昆虫毒液的特异性IgE水平在0.1到0.34之间时，我们是否应该考虑毒液免疫治疗？

毒液免疫疗法（VIT）改善了对叮咬昆虫毒液过敏反应和ige介导致敏的患者的生活质量，并可能挽救生命。致敏的定义是对昆虫毒液的皮肤试验阳性或血清毒液特异性IgE水平等于或高于0.35 kU/L。随着先进诊断技术的出现，敏化水平可低至0.1 kU/L；然而，对于低致敏水平（定义为毒液特异性IgE水平在0.1至0.34 kU/L之间）的患者，该方法仍有争议。此外，在考虑对有较大局部反应或皮肤全身性反应的患者进行VIT治疗时，遇到低水平的致敏会使临床决策复杂化。在这一支持/反对的辩论中，我们讨论了当诊断评估仅显示0.1 - 0.34 kU/L的致敏性且皮肤试验阴性时，对昆虫毒液有过敏反应、皮肤全身反应或大面积局部反应的患者是否应该接受VIT。赞成的观点由Al-Shaikhly博士提出，反对的观点由Craig博士讨论。戈登博士担任主持人和事实核查员。这篇综述不是为了解决医学法律方面的问题，而是为了指导研究和临床研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Allergy and Clinical Immunology-In Practice ALLERGYIMMUNOLOGY-IMMUNOLOGY

CiteScore

11.10

自引率

9.60%

发文量

683

审稿时长

50 days

期刊介绍： JACI: In Practice is an official publication of the American Academy of Allergy, Asthma & Immunology (AAAAI). It is a companion title to The Journal of Allergy and Clinical Immunology, and it aims to provide timely clinical papers, case reports, and management recommendations to clinical allergists and other physicians dealing with allergic and immunologic diseases in their practice. The mission of JACI: In Practice is to offer valid and impactful information that supports evidence-based clinical decisions in the diagnosis and management of asthma, allergies, immunologic conditions, and related diseases. This journal publishes articles on various conditions treated by allergist-immunologists, including food allergy, respiratory disorders (such as asthma, rhinitis, nasal polyps, sinusitis, cough, ABPA, and hypersensitivity pneumonitis), drug allergy, insect sting allergy, anaphylaxis, dermatologic disorders (such as atopic dermatitis, contact dermatitis, urticaria, angioedema, and HAE), immunodeficiency, autoinflammatory syndromes, eosinophilic disorders, and mast cell disorders. The focus of the journal is on providing cutting-edge clinical information that practitioners can use in their everyday practice or to acquire new knowledge and skills for the benefit of their patients. However, mechanistic or translational studies without immediate or near future clinical relevance, as well as animal studies, are not within the scope of the journal.