title: Successful treatment of occupational allergy to bumblebee venom after failure with honeybee venom extract.
abstract: BACKGROUND
  Immediate-type allergies to bumblebee stings occur infrequently. Previous studies have demonstrated a high degree of cross-reactivity between honeybee venom (HBV) and bumblebee venom (BBV). It has been proposed that venom immunotherapy (VIT) with HBV is a therapeutic alternative for patients with BBV allergy.
  
  
  RESULTS
  We present two cases of occupational immediate-type allergies to BBV. Although both nonatopic patients had a negative personal history of previous allergic reactions to honeybee sting, specific IgE antibodies and a positive intradermal reaction to HBV were detected. Despite VIT with HBV, the two developed another severe allergic reaction after incidental bumblebee stings. VIT with BBV, using in one patient a rush protocol and in the other a "conventional" regimen, with escalating doses of 0.01-100 microg of BBV, was performed. Before and during the VIT, the course of IgE and IgG specific antibodies to BBV was analyzed, demonstrating a significant decrease of BBV-IgE and an increase of BBV-IgG. The effectiveness of the treatment was also proven by an in-hospital sting challenge with a live bumblebee.
  
  
  CONCLUSIONS
  Our data demonstrate that cross-immunotherapies with HBV do not protect BBV-allergic patients sufficiently. We conclude that BBV-allergic patients should be treated with BBV. A "rush" VIT with BBV is a safe alternative to a "conventional" protocol.
authors.affiliation: Allergy Unit, Department of Dermatology, University Hospital, Zurich, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Stern
authors.forename: B
authors.initials: B
authors.lastname: Wüthrich
authors.forename: G
authors.initials: G
authors.lastname: Müllner
mesh_terms: D000328:Adult; D000818:Animals; D001514:Bee Venoms / Q000276:immunology / Q000302:isolation & purification / Q000627:therapeutic use*; D001516:Bees; D001733:Bites and Stings / Q000150:complications*; D003429:Cross Reactions / Q000276:immunology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000209:etiology / Q000276:immunology / Q000628:therapy*; D007073:Immunoglobulin E / Q000097:blood; D007074:Immunoglobulin G / Q000097:blood; D008297:Male; D009784:Occupational Diseases / Q000209:etiology / Q000628:therapy*; D011852:Radioallergosorbent Test; D012882:Skin Tests
chemical_list: D001514:Bee Venoms; D007074:Immunoglobulin G; D007073:Immunoglobulin E