Author/Editor		Kopač, Peter; Custovic, Adnan; Zidarn, Mihaela; Šilar, Mira; Šelb, Julij; Bajrović, Nisera; Eržen, Renato; Košnik, Mitja; Korošec, Peter
Title		Biomarkers of the severity of honeybee sting reactions and the severity and threshold of systemic adverse events during immunotherapy
Type		članek
Vol. and No.		Letnik 9, št. 8
Publication year		2021
Volume		str. 3157-3163.e5
ISSN		2213-2201
Language		eng
Abstract		Background. A biomarker that could identify individuals at high risk for severe honeybee sting allergic reaction and/or systemic adverse events (SAEs) during venom immunotherapy (VIT) would improve the management of patients with honeybee (HB) venom allergy. Objective. To identify biomarkers for risk of severe sting reactions or SAEs during VIT. Methods. We recruited 332 patients undergoing honeybee VIT. We ascertained predictors of the severity of the field-sting reaction and the severity and threshold of SAEs during VIT. We assessed the use of cardiovascular medications; baseline serum tryptase (BST) levels; sIgEs to HB venom, rApi m 1 and rApi m 10; and basophil activation test (BAT) response. Results. Significant and independent predictors of a severe honeybee field-sting reaction were age (P=0.008), an absence of skin symptoms (P=0.001), BST (P=0.014), and BAT response at a HB venom concentration of 0.1 mcg/ml (P=0.001). Predictors of severe SAEs during honeybee VIT were age (P=0.025), BST (P=0.006), and BAT response (P=0.001). BAT response was also an individual and significant predictor of any SAEs and SAEs at a low cumulative allergen dose (median 55 mcg) during VIT build-up (P<0.001). The use of [beta]-blockers and angiotensin-converting enzyme inhibitors and sIgE levels were not associated with the severity of honeybee field-sting reactions or VIT SAEs. Conclusions. Baseline serum tryptase and basophil activation are independent risk factors for severe honeybee sting anaphylaxis and SAEs during honeybee VIT. BAT response was the best biomarker for any SAEs and a lower threshold of SAEs during honeybee VIT. These risk factors can help guide recommendations for VIT and overcome systemic reactions to honeybee VIT.
Descriptors		Allergy and immunology Venoms Hypersensitivity Immunotherapy Basophils Drug-related side effects and adverse reactions Alergija in imunologija Živalski strupi Preobčutjivost Imunoterapija Bazofilci Stranski in škodljivi učinki zdravil
Keywords		honeybee allergy systemic adverse events baseline serum tryptase alergija za pik čebele sistemski škodljivi učinki izhodiščna koncentracija triptaze v serumu