title: Influence of total IgE levels on the severity of sting reactions in Hymenoptera venom allergy.
abstract: BACKGROUND
  Detection of specific IgE for Hymenoptera venoms and skin tests are well established diagnostic tools for the diagnosis of insect venom hypersensitivity. The aim of our study was to analyze the effect of total IgE levels on the outcome of generalized anaphylactic reactions after a Hymenoptera sting.
  
  
  METHODS
  Two hundred and twenty patients allergic to bee, wasp, or European hornet venom were included in the study. Their specific and total IgE levels, serum tryptase levels, skin tests, and sting history were analyzed.
  
  
  RESULTS
  In patients with mild reactions (grade I, generalized skin symptoms) we observed higher total IgE levels (248.0 kU/l) compared to patients with moderate reactions (grade II, moderate pulmonary, cardiovascular, or gastrointestinal symptoms; 75.2 kU/l) and severe reactions (grade III, bronchoconstriction, emesis, anaphylactic shock, or loss of consciousness; 56.5 kU/l; P < 0.001). Accordingly, 25% of the patients with low levels of total IgE (<50 kU/l), but no individual with total IgE levels >250 kU/l, developed loss of consciousness (P = 0.001). Additionally, specific IgE levels were related to total IgE levels: Specific IgE levels increased from 1.6 to 7.1 kU/l in patients with low (<50 kU/l) and high (>250 kU/l) total IgE levels, respectively (P < 0.001). Specific IgE levels correlated inversely to the clinical reaction grades, however, this trend was not statistically significant (P = 0.083).
  
  
  CONCLUSIONS
  Patients with Hymenoptera venom allergy and high levels (>250 kU/l) of total IgE, predominantly develop grade I and grade II reactions and appear to be protected from grade III reactions. However, this hypothesis should be confirmed by extended studies with sting challenges.
authors.affiliation: Department of Environmental Dermatology and Allergy, Medical University of Graz, Auenbruggerplatz, Graz, Austria.
authors.forename: G J
authors.initials: GJ
authors.lastname: Sturm
authors.forename: A
authors.initials: A
authors.lastname: Heinemann
authors.forename: C
authors.initials: C
authors.lastname: Schuster
authors.forename: M
authors.initials: M
authors.lastname: Wiednig
authors.forename: A
authors.initials: A
authors.lastname: Groselj-Strele
authors.forename: E M
authors.initials: EM
authors.lastname: Sturm
authors.forename: W
authors.initials: W
authors.lastname: Aberer
mesh_terms: D000328:Adult; D000367:Age Factors; D000707:Anaphylaxis / Q000209:etiology / Q000276:immunology; D000818:Animals; D001514:Bee Venoms / Q000276:immunology*; D016084:Bronchoconstriction / Q000276:immunology; D005260:Female; D006801:Humans; D006927:Hymenoptera / Q000276:immunology*; D006967:Hypersensitivity / Q000097:blood / Q000175:diagnosis / Q000276:immunology*; D007073:Immunoglobulin E / Q000097:blood / Q000276:immunology*; D007299:Insect Bites and Stings / Q000276:immunology*; D008297:Male; D012720:Severity of Illness Index; D012882:Skin Tests / Q000379:methods; D053802:Tryptases / Q000097:blood; D014474:Unconsciousness / Q000209:etiology / Q000276:immunology; D014839:Vomiting / Q000209:etiology / Q000276:immunology
chemical_list: D001514:Bee Venoms; D007073:Immunoglobulin E; D053802:Tryptases