D1.162 - Selecting the right immunotherapy for Vespa velutina nigrithorax anaphylaxis: does one treatment fits all?
Case report
The accidental introduction of Vespa velutina nigrithorax (VVN) in Europe in 2004 has led to a growing incidence of cases of anaphylaxis across the continent. On the basis of the well-known cross-reactivity among allergens from different Vespidae, venom immunotherapy (VIT) options for VVN relied on venom extracts from other Hymenoptera species. However, currently VIT option for VVN has become available.
This report describes a 11-year-old boy, that developed a Grade III Muller anaphylaxis minutes after being stung for the first time by a VVN. There were previous Vespula and Apis mellifera stungs, experiencing only local reactions. The sensitization profile was studied: Basal Tryptase 2.31ug/L. IgE Vespula spp. 5.88 KUA/L, Ves v 5 2.58 KUA/L and Ves v 1 0.90KUA/L; IgE Polistes spp. 4.74 KUA/L, Polistes dominula 6.66 kUA/Land Pol d 5 2.72 KUA/L. IgE Vespa crabro 10.1 KUA/L. IgE vespa velutina 1001 KUA/L.
The ImmunoCAP inhibition test was performed and revealed genuine sensitization to Apis mellifera, Vespula spp., and Polistes dominula. The sensitization to VVN was attributed to cross-reactive allergens from groups 5 and 1, and likely groups 3 and 2. Inhibition results demonstrated significant (>70%) homologous inhibition but not heterologous inhibition with venoms from V. germanica + V. vulgaris and P. dominula. On the contrary, inhibition with VVN venom did not yield relevant inhibition, either homologous or heterologous, showing only slightly higher inhibition in homologous VVN (50%) compared to heterologous inhibition with the Vespula + Polistes mix (41%). Taking all this into account, the study revealed that the ideal treatment would be dual immunotherapy with P. dominula and Vespula germanica + V. vulgaris, without including VVN venom.
In this report, we present a case with a complex sensitization profile. Although the index reaction was caused by VVN, the specific VVN vaccine surprisingly did not emerge as the most suitable option for this patient, and this raises the question whether the newly developed VVN VIT must be beneficial compared to VIT from other Vespidae hymenoptera.
