Background:Vespa orientalis (VO) stings occasionally induce anaphylaxis. In the absence of commercial VO venom, allergists use commercial venoms for immunotherapy, despite having no indication regarding efficacy. We attempted to examine the effectiveness of immunotherapy with commercial venoms in patients with VO allergy and to identify the venom accountable for this effect. Methods: Patients who unequivocally identified VO as the culprit insect were administered venom immunotherapy with the commercial venoms available in Israel to which they had positive skin tests. Patients were also skin tested with VO venom sac extracts and, after reaching the maintenance dose, were sting challenged by a live insect. The allergenic components in the venom were determined by immunoblotting. Results: Twelve patients were recruited and, based on their skin test results, all were treated with yellow jacket (YJ) venom, either alone or combined with other venoms. All 8 patients who were sting challenged by VO demonstrated positive skin test responses to VO venom. Six of the stung patients tolerated the sting challenge uneventfully. Two patients developed minimal transient symptoms that resolved spontaneously. SDS-PAGE with patient sera suggested cross-reactivity between VO and YJ venoms at molecular weights of 39–42 kDa. Using phospholipases, antigen 5 and hyaluronidase derived from several Vespa, Dolichovespula and Vespula species, hyaluronidase is possibly accountable for inducing the allergic reaction. Conclusion: In the absence of commercial VO venom the practice of treating patients allergic to this insect with available commercial venoms seems to be efficacious and YJ venom is probably responsible for this effect.

Keywords:
Yellow jacket, Immunotherapy, Venom allergy, Vespa orientalis
1.
Archer ME: Taxonomy, distribution and nesting biology of Vespa orientalis L. (Hymenoptera, Vespidae). Entomol Month Mag 1998:134: 45–51.
2.
Carpenter JM, Kojima J: Checklist of the species in the subfamily Vespinae (Insecta: Hymenoptera:Vespinae). Nat Hist Bull Ibaraki Univ 1997:1:51–92.
3.
Goldberg A, Confino-Cohen R: A simple device for deliberate Hymenoptera sting challenge. J Allergy Clin Immunol 1997:100:139–141.
4.
Goldberg A, Confino-Cohen R, Mekori YA: Deliberate hymenoptera sting challenge as a diagnostic tool in highly selected venom-allergic patients. Ann Allergy Asthma Immunol 1995:75:30–32.
5.
Chugh KS, Sharma BK, Singhal PC: Acute renal failure following hornet stings. J Trop Med Hyg 1976:79:42–44.
6.
Sakhuja V, Bhalla A, Pereira BJ, Kapoor MM, Bhusnurmath SR, Chugh KS: Acute renal failure following multiple hornet stings. Nephron 1988:49:319–321.
7.
Sharma A, Wanchu A, Mashesha V, Sakhuja V, Bambery P, Singh S: Acute tubulo-interstitial nephritis leading to acute renal failure following multiple hornet stings. BMC Nephrol 2006:7:18.
8.
Korman SH, Jabbour S, Harari MD: Multiple hornet (Vespa orientalis) stings with fatal outcome in a child. J Paediatr Child Health 1990:26:283–285.
9.
Watemberg N, Weizman Z, Shahak E, Aviram M, Maor E: Fatal multiple organ failure following massive hornet stings. J Toxicol Clin Toxicol 1995:33:471–474.
10.
Weizman Z, Mussafi H, Ishay JS, Shvil Y, Goitein K, Livni N, Deckelbaum RJ: Multiple hornet stings with features of Reye’s syndrome. Gastroenterology 1985:89:1407–1410.
11.
Panzani R, Blanca M, Sanchez F, Juarez C:Sensitivity to European wasps in a group of allergic patients in Marseille: preliminary results. J Investig Allergol Clin Immonol 1994: 4:42–46.
12.
Blanca M, Garcia F, Miranda A, Carmona MJ, Garcia J, Fernandez J, Terrados S, Vega JM, Juarez C: Determination of IgE antibodies to Polistes dominilus, Vespula germanica and Vespa crabro in sera of patients allergic to vespids. Allergy 1991:46:109–114.
13.
Saggese S: Su di un nuovo caso mortale da puntura di Vespa crabro (A new fatal case of Vespa crabro sting). Nuovi Ann Ig Microbiol 1956:7:306–308.
14.
Korantzopoulos P, Kountouris E, Voukelatou M, Charaktsis I, Dimitroula V, Siogas K: Acute myocardial infarction after a European hornet sting – a case report. Angiology 2006:57: 383–386.
15.
Antonicelli L, Bilo M, Napoli G, Farabollini B, Bonifazi F: European hornet (Vespa crabro) sting:a new risk factor for life-threatening reaction in hymenoptera allergic patients? Allerg Immunol (Paris) 2003:35:199–203.
16.
Hoffman DR, McDonald CA: Allergens in hymenoptera venom. VII. Species specific reactivity to yellow jacket venoms. Ann Allergy 1981:47:23–27.
17.
Levick NR, Winkel KD, Smith G: European wasps: an emerging hazard in Australia. Med J Aust 1997:167:650–651.
18.
Dvořák L: Oriental hornet Vespa orientalis Linnaeus, 1771 found in Mexico (Hymenoptera, Vespidae, Vespinae). Entomological Problems 2006:36:80.
19.
Mueller U, Elliott W, Reisman R, Ishay J, Walsh S, Steger R, Wypych J, Arbesman C: Comparison of biochemical and immunologic properties of venoms from four hornet species. J Allergy Clin Immunol 1981:67:290–298.
20.
Kosnik M, Korosec P, Silar M, Music E, Erzen R: Wasp venom is appropriate for immunotherapy of patients with allergic reaction to the European hornet sting. Croat Med J 2002:43:25–27.
21.
Sturm G, Kränke B, Rudolph C, Aberer W:Rush Hymenoptera venom immunotherapy: a safe and practical protocol for high-risk patients. J Allergy Clin Immunol 2002:110: 928–933.
22.
Fernández J: Distribution of vespid species in Europe. Curr Opin Allergy Clin Immunol 2004:4:319–324.
23.
King TP, Spangfort MD: Structure and biology of stinging insect venom allergens. Int Arch Allergy Immunol 2000:123:99–106.
24.
Hoffman DR: Hymenoptera venom allergens. Clin Rev Allergy Immunol 2006:30:109–128.
25.
Hoffman DR: Allergens in Hymenoptera venom XVI: studies of the structures and cross-reactivities of vespid venom phospholipases. J Allergy Clin Immunol 1986:78:337–343.
26.
Hoffman DR, Jacobson RS, Zebroni R: Allergens in Hymenoptera venom. XIX. Allergy to Vespa crabro, the European hornet. Int Arch Allergy Appl Immunol 1987:84:25–31.
27.
Hoffman DR: Allergens in Hymenoptera venon. XXV. The amino acid sequences of antigen 5 molecules and the structural basis of antigenic cross-reactivity. J Allergy Clin Immunol 1993:92:707–716.
28.
Severino MG, Caruso B, Bonadonna P, Macchia D, Campi P, Passalacqa G: Cross reactivity between European hornet and yellow jacket venoms. Eur Ann Allergy Clin Immunol 2010:42:141–145.
29.
Jin C, Focke M, Léonard R, Jarich R, Altman F, Hemmer W: Reassessing the role of hyaluronidase in yellow jacket venom allergy. J Allergy Clin Immunol 2010:125:184–190.
30.
Seismann H, Blank S, Braren I, Greunke K, Cifuentes L, Grunwald T, Bredehorst R, Ollert M, Spillner E: Dissecting cross-reactivity in hymenoptera venom allergy by circumvention of alpha-1,3-core fucosylation. Mol Immunol 2010:47:799–808.
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2013
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