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Current challenges in molecular diagnostics of insect venom allergy

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  • Current challenges in molecular diagnostics of insect venom allergy
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Abstract

Background: Advanced component-resolved diagnostics (CRD) in Hymenoptera venom allergy (HVA) has improved the precise description of individual sensitization profiles. However, diagnostic gaps, peptide-based cross-reactivity, early identification of severe reactors and diagnosis of patients with a clear history of sting reactions but negative specific IgE and skin tests, remain challenging.

Methods: Systematic literature search in PubMed and critical analysis of recently published studies on insect venom allergy diagnostics.

Results and discussion: CRD has increased the sensitivity of IgE testing and improved the discrimination of primary sensitization from irrelevant cross-reactivity, ultimately providing a better rationale for therapeutic decisions. Despite these major advances, there is still room for improvement in routine HVA diagnostics. Peptide based cross-reactivity among homologous allergens from Vespinae and Polistinae venoms as well as still existing diagnostic gaps are particularly challenging. No marker allergens are currently available to differentiate Vespula and Polistes sensitizations. Several strategies including clinical setting of basophil activation test (BAT) for routine diagnostics, venomic analysis for the identification of novel allergens and characterization of the molecular basis of cross-reactivity could be used to address major limitations and unresolved issues in molecular diagnostics of HVA.

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Acknowledgements

The authors want to thank the financial support from the Sao Paulo Research Foundation (FAPESP) (Grant #2016/16212-5) and INCT/CNPq-iii. APR is a Post-Doctoral Fellow from FAPESP (Grant #2017/22405- 3, #2018/24834-1). We acknowledge Prof. Dr. Alexis Musacchio Lasa for the collaboration in the structural modelling analyses.

This work was partially presented by T. Jakob as a lecture in the EAACI Allergy School on Insect Venom Allergy and Mastocytosis held in Groningen, The Netherlands, April 11-13, 2019.

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Authors and Affiliations

  1. Department of Dermatology and Allergology, University Medical Center Gießen (UKGM), Gießen, Germany

    Amilcar Perez-Riverol

  2. Center for the Study of Social Insects (CEIS), Department of Biology, Institute of Biosciences of Rio Claro, University of Sao Paulo State (UNESP/RC), Rio Claro, SP, Brazil

    Mario Sergio Palma

  3. Klinik für Dermatologie, Venerologie und Allergologie, University Medical Center Gießen (UKGM), Justus Liebig University Gießen, Gaffkystraße 14, 35392, Gießen, Germany

    Thilo Jakob

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  1. Amilcar Perez-Riverol
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Correspondence to Thilo Jakob.

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T. Jakob reports grants, personal fees and non-financial support from Novartis, personal fees and non-financial support from Thermo Fisher Scientific, grants and personal fees from ALK-Abello, personal fees from Celgene, personal fees and non-financial support from Bencard/Allergy Terapeutics, personal fees from Allergopharma. A. Perez-Riverol and M.S. Palma declare that they have no competing interests.

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Perez-Riverol, A., Palma, M. & Jakob, T. Current challenges in molecular diagnostics of insect venom allergy. Allergo J 29, 38–49 (2020). https://doi.org/10.1007/s15007-020-2518-1

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