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In vitro testing to diagnose venom allergy and monitor immunotherapy: a placebo-controlled, crossover trial

Citation

Brown, SGA and Haas, MA and Black, JA and Parameswaran, A and Woods, GM and Heddle, RJ, In vitro testing to diagnose venom allergy and monitor immunotherapy: a placebo-controlled, crossover trial, Clinical and Experimental Immunology, 34, (5) pp. 792-800. ISSN 0954-7894 (2004) [Refereed Article]

DOI: doi:10.1111/j.1365-2222.2004.01949.x

Abstract

Background: In people with a history of sting allergy, only prior reaction severity and older age are known to predict subsequent reaction risk. Furthermore, no diagnostic test other than a deliberate sting challenge has been found to identify people in whom venom immunotherapy (VIT) has been unsuccessful. Objective: We aimed to assess the utility of a number of in vitro tests to diagnose venom allergy and to monitor immunotherapy. Methods: During a double-blind randomized placebo-controlled crossover trial of Myrmecia pilosula ant VIT the following venom-specific tests were performed at enrolment, and at completion of treatment prior to a diagnostic sting challenge; leucocyte stimulation index (SI), IL-4 production, IgE RAST, histamine release test (HRT), leukotriene release test (LRT) and basophil activation test (BAT). Intradermal venom skin testing (VST) was also performed at trial entry. Results: Only VST and HRT identified those at risk of sting anaphylaxis in the placebo group. Although IgE RAST, leucocyte SI and IL-4 production, LRT and BAT all correlated well with intradermal VSTs, they did not predict sting challenge outcome. After successful VIT, venom-induced leucocyte IL-4 production tended to fall, whereas IgE RAST increased and a natural decline in HRT reactivity was reversed. A confounding seasonal affect on laboratory results was suspected. Conclusion: The HRT warrants further assessment for diagnosis of venom allergy. Uninformative performance of the commercially available LRT and BAT tests may be due to pre-incubation with IL-3. None of the tests evaluated appear to be reliable markers of successful VIT.

Item Details

Item Type:Refereed Article
Research Division:Medical and Health Sciences
Research Group:Immunology
Research Field:Cellular Immunology
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Immune System and Allergy
Author:Haas, MA (Dr Matilda Haas)
Author:Black, JA (Mr James Black)
Author:Parameswaran, A (Mr Anand Parameswaran)
Author:Woods, GM (Professor Gregory Woods)
ID Code:32382
Year Published:2004
Web of Science® Times Cited:20
Deposited By:Pathology
Deposited On:2004-08-01
Last Modified:2011-09-29
Downloads:0

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