Clinical correlation of the venom-specific IgG antibody level during maintenance venom immunotherapy.
Allergen immunotherapy is associated with a significant increase of specific IgG antibodies that have been suggested as a mechanism of action and as a marker of efficacy for immunotherapy. The value of venom-specific IgG antibody determinations as a measure of clinical protection against sting anaphylaxis has been difficult to prove in individual patients. We performed 211 insect sting challenges in 109 patients over a 4-year period to determine the significance of venom IgG levels 3 micrograms/ml or lower. Systemic symptoms occurred in only 1.6% of those with venom IgG more than 3 micrograms/ml, but in 16% of those with less than 3 micrograms/ml IgG, and notably in 26% of patients with low venom IgG who had received less than 4 years of treatment. The venom IgG level had no predictive value in patients who had received more than 4 years of therapy. Honeybee sting data were inconclusive because of the small number of subjects. We conclude that low venom-specific IgG levels are associated with an elevated risk of treatment failure during the first 4 years of immunotherapy with yellow jacket or mixed vespid venoms.
Golden
D B
DB
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Lawrence
I D
ID
Hamilton
R H
RH
Kagey-Sobotka
A
A
Valentine
M D
MD
Lichtenstein
L M
LM
D000328:Adult; D001514:Bee Venoms / Q000276:immunology* / Q000627:therapeutic use; D003888:Desensitization, Immunologic; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis*; D007299:Insect Bites and Stings / Q000276:immunology* / Q000628:therapy; D008875:Middle Aged; D012306:Risk; D014862:Wasp Venoms / Q000276:immunology* / Q000627:therapeutic use
D001514:Bee Venoms; D007074:Immunoglobulin G; D014862:Wasp Venoms