The Experts below are selected from a list of 213 Experts worldwide ranked by ideXlab platform
James M Tracy - One of the best experts on this subject based on the ideXlab platform.
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Insect Allergy: Unanswered Questions, a Postscript
Stinging Insect Allergy, 2017Co-Authors: James M TracyAbstract:There are few conditions that are as treatable as Hymenoptera venom Allergy. It also is a window into other conditions such as mast cell disease and anaphylaxis. Over the years, much work has been accomplished to help our patients and better understand this potentially lethal but highly treatable condition. Our understanding of risk factors, improved diagnostic modalities, and potential comorbid conditions have been instrumental in constructing an exceptional, data-driven approach to Hymenoptera venom Allergy. Unfortunately, to answer a question there is not always perfect data, and periodically, there is no way to ethically obtain it. In most of those cases, there is often consensus. However, in the end, there will always be unanswered questions. These are a few of those unanswered questions.
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A 'difficult' Insect Allergy patient: reliable history of a sting, but all testing negative.
Current opinion in allergy and clinical immunology, 2015Co-Authors: James M Tracy, Jonathan A. Olsen, John CarlsonAbstract:PURPOSE OF REVIEW: Few conditions are as treatable as Allergy to stinging Insects, with venom immunotherapy (VIT) providing up to 98% protection to subsequent stings. The challenge with VIT is not in the treatment, but in the diagnosis. To offer VIT, one must determine a history of a systemic reaction to a stinging Insect in conjunction with the presence venom-specific IgE. Current diagnostic methods, although sensitive and specific, are imperfect, and some newer testing options are not widely available. A conundrum occasionally faced is the patient with a reliable and compelling history of a systemic allergic reaction yet negative venom-specific testing. This diagnostic dilemma presents an opportunity to consider possible causes for this diagnostic challenge. RECENT FINDINGS: Our evolving understanding of the role of occult mast cell disease may begin to help us understand this situation and develop appropriate management strategies. Venom-specific skin testing has long been the cornerstone of the evaluation of venom sensitivity and is often combined with in-vitro assays to add clarity, but even these occasionally may fall short. Exploring novel venom diagnostic testing methods may help to fill in some of the diagnostic gaps. Do currently available venom vaccines contain all the key venom species? Are there enough differences between Insect species that we may simply be missing the relevant allergens? What is the significance of the antigenicity of carbohydrate moieties in venoms? What is the role of recombinant venom extracts? SUMMARY: VIT is the definitive treatment for Insect allergic individuals. To utilize VIT, identification of the relevant Hymenoptera is necessary. Unfortunately, this cannot always be accomplished. This deficiency can have several causes: a potential comorbid condition such as occult mast cell disease, limitations of currently available diagnostic resources, or testing vaccines with an insufficient coverage of relevant venom allergens. Exploring these potential causes may help to provide important insight into this important diagnostic conundrum. The use of a case report may help clarify this challenge. Language: en
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Insect anaphylaxis: where are we? The stinging facts 2012.
Current opinion in allergy and clinical immunology, 2012Co-Authors: James M Tracy, Fatima S. Khan, Jeffrey G. DemainAbstract:Purpose of review Insect Allergy remains an important cause of morbidity and mortality in the United States. In 2011, the third iteration of the stinging Insect hypersensitivity practice parameter was published, the first being published in 1999 and the second in 2004. Since the 2004 edition, our understanding of Insect hypersensitivity has continued to expand and has been incorporated into the 2011 edition. This work will review the relevant changes in the management of Insect hypersensitivity occurring since 2004 and present our current understanding of the Insect hypersensitivity diagnosis and management. Recent findings Since the 2004 commissioning by the Joint Task Force (JTF) on Practice Parameters of ‘Stinging Insect hypersensitivity: a practice parameter update’, there have been important contributions to our understanding of Insect Allergy. These contributions were incorporated into the 2011 iteration. Similar efforts were made by the European Allergy Asthma and Clinical Immunology Interest Group in 2005 and most recently in 2011 by the British Society of Allergy and Clinical Immunology. Summary Our understanding of Insect Allergy, including the natural history, epidemiology, diagnostic testing, and risk factors, has greatly expanded. This evolution of knowledge should provide improved long-term management of stinging Insect hypersensitivity. This review will focus primarily on the changes between the 2004 and 2011 stinging Insect practice parameter commissioned by the JTF on Practice Parameters, but will, where appropriate, highlight the differences between working groups.
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Insect Allergy.
The Mount Sinai journal of medicine New York, 2011Co-Authors: James M TracyAbstract:Anaphylaxis is a life-threatening allergic condition. The 3 most common triggers for anaphylaxis are food, medications, and Insects. All of these triggers are the sources of considerable morbidity and mortality, but of the 3, only Insect Allergy is treatable through means other than trigger avoidance. Because ≥ 40 deaths per year are attributed to Insect stings, it is critical that healthcare providers and the public understand the proper diagnosis as well as the long-term treatment of this potentially life-threatening Allergy. Unlike food and medication Allergy, which are managed primarily by allergen avoidance, Hymenoptera Allergy is managed prospectively using venom immunotherapy; this results in a protective level of up to 98%. Insects of the order Hymenoptera include bees, wasps, hornets, yellowjackets, and ants. They are responsible for the majority of the fatal and near-fatal sting events. Understanding the biology and habitat of the various Hymenoptera species is helpful in recommending Insect-avoidance strategies. The diagnosis of Insect Allergy relies on a history of a systemic allergic reaction with appropriate testing for venom-specific immunoglobulin E. If the history of a systemic reaction to an Insect sting and the presence of venom specific immunoglobulin E is confirmed, venom immunotherapy is indicated. The proper and primary means of treating acute anaphylaxis is immediate epinephrine-and studies suggest that it is underutilized in the acute setting. However, it is venom immunotherapy, a disease-modifying therapy, that provides the affected individual with the most effective protection against future sting reactions. Long-term management of Insect Allergy and anaphylaxis includes appropriate referral to an allergist familiar with Insect Allergy and, if indicated, venom immunotherapy.
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Insect anaphylaxis: addressing clinical challenges.
Current opinion in allergy and clinical immunology, 2011Co-Authors: James M Tracy, Elena J. Lewis, Jeffrey G. DemainAbstract:Purpose of review Few allergic reactions are as potentially life-threatening, or frightening to the patient, as anaphylaxis. Food, medications, and Insect stings are the three most common triggers of anaphylaxis, but Insect Allergy provides the best opportunity to understand the biology of anaphylaxis. If the physician can establish a diagnosis of Insect Allergy, treatment with nearly 98% effectiveness can be initiated. However, sometimes patients have a compelling history of Insect sting anaphylaxis, but negative skin and blood tests. This situation presents us with a fascinating opportunity to understand the biology of Insect anaphylaxis. Recent findings Recent and ongoing work shows that occult mast cell disease may be critical in Insect anaphylaxis. Mastocytosis, serum tryptase and basophil biology are key elements; genetic markers may potentially help us diagnose at-risk individuals and determine proper treatment. Understanding basophil activation may play an additional role both in diagnosis and knowing when therapy might be terminated. Summary Mast cell disease, serum tryptase and basophil biology are providing an opportunity to better understand and manage Insect Allergy. This evolving understanding should improve long-term management of Insect anaphylaxis and help us to better understand the clinical dilemma of appropriate management of the history-positive patient in which testing is unable to detect venom-specific IgE. Furthermore, omalizumab's immunomodulatory effects may play a role in difficult-to-treat Insect Allergy and mastocytosis. Finally, unrelated to these, but still important as an ongoing risk factor, is the continued underutilization of epinephrine for both acute and long-term management of Insect anaphylaxis.
David B.k. Golden - One of the best experts on this subject based on the ideXlab platform.
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Approach to Patients with Stinging Insect Allergy.
The Medical clinics of North America, 2019Co-Authors: Elissa M. Abrams, David B.k. GoldenAbstract:Stinging Insect Allergy is uncommon but can be life threatening. Diagnosis requires clinical history and confirmative skin or blood testing by an allergist. Baseline serum tryptase level can be used to stratify risk. Treatment is supportive for all reactions except for anaphylaxis, which is treated with intramuscular epinephrine, recumbent posture, and adjunct measures such as IV fluids, and oxygen. Venom immunotherapy is most effective for long-term management in patients with a history of anaphylaxis. Venom immunotherapy rapidly reduces the risk of sting anaphylaxis by up to 98% and maintenance treatment can be stopped after 5 years in most cases.
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Chapter 15 – Insect Allergy
Middleton's Allergy Essentials, 2017Co-Authors: David B.k. GoldenAbstract:Systemic reactions to Insect stings are reported by 3% of adults and can be fatal even on the first reaction. Large local reactions are more frequent than systemic reactions, but rarely dangerous. The chance of a systemic reaction to a sting is low (5–10%) in children and adults with a history of large local reactions and in children with mild (cutaneous) systemic reactions, and varies between 30% and 65% in adults with previous systemic reactions, depending on the severity of previous sting reactions. Venom sensitization can be detected in 20% of normal adults, so the history is most important in clinical evaluation. Venom skin tests are most sensitive for diagnosis but the serum-specific IgE test is an important complementary test. The level of venom-IgE detected by the skin test or serum test does not, however, reliably predict the severity of a sting reaction. Baseline serum tryptase is elevated in many patients with sting anaphylaxis, and should be evaluated as a predictor of severe reactions. Venom immunotherapy is safe and is 75–98% effective in preventing sting anaphylaxis; it also significantly reduces the risk of large local reactions. Most patients can discontinue treatment after 5 years, with very low residual risk of a severe sting reaction.
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chapter 15 Insect Allergy
Middleton's Allergy Essentials, 2017Co-Authors: David B.k. GoldenAbstract:Systemic reactions to Insect stings are reported by 3% of adults and can be fatal even on the first reaction. Large local reactions are more frequent than systemic reactions, but rarely dangerous. The chance of a systemic reaction to a sting is low (5–10%) in children and adults with a history of large local reactions and in children with mild (cutaneous) systemic reactions, and varies between 30% and 65% in adults with previous systemic reactions, depending on the severity of previous sting reactions. Venom sensitization can be detected in 20% of normal adults, so the history is most important in clinical evaluation. Venom skin tests are most sensitive for diagnosis but the serum-specific IgE test is an important complementary test. The level of venom-IgE detected by the skin test or serum test does not, however, reliably predict the severity of a sting reaction. Baseline serum tryptase is elevated in many patients with sting anaphylaxis, and should be evaluated as a predictor of severe reactions. Venom immunotherapy is safe and is 75–98% effective in preventing sting anaphylaxis; it also significantly reduces the risk of large local reactions. Most patients can discontinue treatment after 5 years, with very low residual risk of a severe sting reaction.
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New directions in diagnostic evaluation of Insect Allergy.
Current opinion in allergy and clinical immunology, 2014Co-Authors: David B.k. GoldenAbstract:Purpose of reviewDiagnosis of Insect sting Allergy and prediction of risk of sting anaphylaxis are often difficult because tests for venom-specific IgE antibodies have a limited positive predictive value and do not reliably predict the severity of sting reactions.Recent findingsComponent-resolved di
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Insect Allergy in children.
Current opinion in allergy and clinical immunology, 2006Co-Authors: David B.k. GoldenAbstract:Purpose of reviewSome aspects of Insect sting Allergy are unique in children. This review will identify and update the published data that exist pertaining specifically to Insect Allergy in children.Recent findingsChildren have a different pattern of Insect sting Allergy than adults. Honeybee allerg
Anja Mediaty - One of the best experts on this subject based on the ideXlab platform.
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Total and specific serum IgE decreases with age in patients with allergic rhinitis, asthma and Insect Allergy but not in patients with atopic dermatitis
Immunity & ageing : I & A, 2005Co-Authors: Anja Mediaty, Neuber KAbstract:Concerning allergic diseases, the incidence of allergic symptoms, as well as their severity, seems to decrease with age. The decline of onset of allergic symptoms observed in ageing might result from a decrease of serum total and specific IgE. Atopic disorders are complex diseases that involve interactions among several physiological systems, e.g. skin, lung, mucosae, and the immune system. It was the aim of this study to compare the effects of age on total and specific IgE in patients with atopic dermatitis (AD), allergic rhinitis or asthma, and Insect Allergy, respectively. The study population consisted of 559 individuals (male: 229 and female: 330). Total and allergen specific IgE was measured in every individual. From the whole study population, 113 patients suffered from atopic dermatitis (AD), 132 had allergic rhinitis or asthma, and 314 were tested because of Insect Allergy. Total and specific serum IgE was significantly decreased as a function of age in patients with allergic rhinitis and asthma and with Insect Allergy. In contrast, no significant decrease of total and specific serum IgE in old individuals with AD was observed. Additionally, in the group of patients with a total IgE 300 kU/l showed no correlation with age. Immunosenescence does not affect increased IgE levels in atopic patients with AD and/or high serum IgE levels indicating that in these subgroups of patients the atopic propensity remains into advanced age. One may hypothesize that either onset of allergic sensitization during life or the kind of atopic disease influences the correlation between age and IgE synthesis.
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Total and specific serum IgE decreases with age in patients with allergic rhinitis, asthma and Insect Allergy but not in patients with atopic dermatitis
Immunity & Ageing, 2005Co-Authors: Anja Mediaty, Karsten NeuberAbstract:Concerning allergic diseases, the incidence of allergic symptoms, as well as their severity, seems to decrease with age. The decline of onset of allergic symptoms observed in ageing might result from a decrease of serum total and specific IgE. Atopic disorders are complex diseases that involve interactions among several physiological systems, e.g. skin, lung, mucosae, and the immune system. It was the aim of this study to compare the effects of age on total and specific IgE in patients with atopic dermatitis (AD), allergic rhinitis or asthma, and Insect Allergy, respectively. The study population consisted of 559 individuals (male: 229 and female: 330). Total and allergen specific IgE was measured in every individual. From the whole study population, 113 patients suffered from atopic dermatitis (AD), 132 had allergic rhinitis or asthma, and 314 were tested because of Insect Allergy. Total and specific serum IgE was significantly decreased as a function of age in patients with allergic rhinitis and asthma and with Insect Allergy. In contrast, no significant decrease of total and specific serum IgE in old individuals with AD was observed. Additionally, in the group of patients with a total IgE < 300 kU/l a reduction of total serum IgE was significantly correlated with age. In contrast, patients with IgE levels > 300 kU/l showed no correlation with age. Immunosenescence does not affect increased IgE levels in atopic patients with AD and/or high serum IgE levels indicating that in these subgroups of patients the atopic propensity remains into advanced age. One may hypothesize that either onset of allergic sensitization during life or the kind of atopic disease influences the correlation between age and IgE synthesis.
Jeffrey G. Demain - One of the best experts on this subject based on the ideXlab platform.
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Insect anaphylaxis: where are we? The stinging facts 2012.
Current opinion in allergy and clinical immunology, 2012Co-Authors: James M Tracy, Fatima S. Khan, Jeffrey G. DemainAbstract:Purpose of review Insect Allergy remains an important cause of morbidity and mortality in the United States. In 2011, the third iteration of the stinging Insect hypersensitivity practice parameter was published, the first being published in 1999 and the second in 2004. Since the 2004 edition, our understanding of Insect hypersensitivity has continued to expand and has been incorporated into the 2011 edition. This work will review the relevant changes in the management of Insect hypersensitivity occurring since 2004 and present our current understanding of the Insect hypersensitivity diagnosis and management. Recent findings Since the 2004 commissioning by the Joint Task Force (JTF) on Practice Parameters of ‘Stinging Insect hypersensitivity: a practice parameter update’, there have been important contributions to our understanding of Insect Allergy. These contributions were incorporated into the 2011 iteration. Similar efforts were made by the European Allergy Asthma and Clinical Immunology Interest Group in 2005 and most recently in 2011 by the British Society of Allergy and Clinical Immunology. Summary Our understanding of Insect Allergy, including the natural history, epidemiology, diagnostic testing, and risk factors, has greatly expanded. This evolution of knowledge should provide improved long-term management of stinging Insect hypersensitivity. This review will focus primarily on the changes between the 2004 and 2011 stinging Insect practice parameter commissioned by the JTF on Practice Parameters, but will, where appropriate, highlight the differences between working groups.
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Insect anaphylaxis: addressing clinical challenges.
Current opinion in allergy and clinical immunology, 2011Co-Authors: James M Tracy, Elena J. Lewis, Jeffrey G. DemainAbstract:Purpose of review Few allergic reactions are as potentially life-threatening, or frightening to the patient, as anaphylaxis. Food, medications, and Insect stings are the three most common triggers of anaphylaxis, but Insect Allergy provides the best opportunity to understand the biology of anaphylaxis. If the physician can establish a diagnosis of Insect Allergy, treatment with nearly 98% effectiveness can be initiated. However, sometimes patients have a compelling history of Insect sting anaphylaxis, but negative skin and blood tests. This situation presents us with a fascinating opportunity to understand the biology of Insect anaphylaxis. Recent findings Recent and ongoing work shows that occult mast cell disease may be critical in Insect anaphylaxis. Mastocytosis, serum tryptase and basophil biology are key elements; genetic markers may potentially help us diagnose at-risk individuals and determine proper treatment. Understanding basophil activation may play an additional role both in diagnosis and knowing when therapy might be terminated. Summary Mast cell disease, serum tryptase and basophil biology are providing an opportunity to better understand and manage Insect Allergy. This evolving understanding should improve long-term management of Insect anaphylaxis and help us to better understand the clinical dilemma of appropriate management of the history-positive patient in which testing is unable to detect venom-specific IgE. Furthermore, omalizumab's immunomodulatory effects may play a role in difficult-to-treat Insect Allergy and mastocytosis. Finally, unrelated to these, but still important as an ongoing risk factor, is the continued underutilization of epinephrine for both acute and long-term management of Insect anaphylaxis.
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Anaphylaxis and Insect Allergy.
Current opinion in allergy and clinical immunology, 2010Co-Authors: Jeffrey G. Demain, Ashley A Minaei, James M TracyAbstract:Purpose of reviewAnaphylaxis is an acute-onset and potentially life-threatening allergic reaction that can be caused by numerous allergic triggers including stinging Insects. This review focuses on recent advances, natural history, risk factors and therapeutic considerations.Recent findingsRecent wo
R Jarisch - One of the best experts on this subject based on the ideXlab platform.
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identification by immunoblot of venom glycoproteins displaying immunoglobulin e binding n glycans as cross reactive allergens in honeybee and yellow jacket venom
Clinical & Experimental Allergy, 2004Co-Authors: Wolfgang Hemmer, Daniel Kolarich, M Gotz, M Focke, I Dalik, R JarischAbstract:Summary Background IgE antibodies against carbohydrate epitopes have been identified recently as a major cause of in vitro double positivity to honeybee (HB) and vespid venom in patients with stinging-Insect Allergy. As these antibodies possibly have low clinical relevance they may be misleading in the diagnosis of venom Allergy. Objective To confirm the role of carbohydrate epitopes in double positivity and to locate the responsible glycoallergens in HB and yellow jacket (YJ) venom by western blot. Methods Immunoblot inhibition using HB venom, YJ venom and two glycoprotein sources displaying 1-3-fucosylated N-glycans (i.e. oilseed rape (OSR) pollen, and the synthetic neo-glycoprotein fucosylated/xylosylated N-glycans from bromelain coupled to bovine serum albumin (MUXF-BSA)) as inhibitors were performed with sera from 15 double-positive patients with stinging-Insect Allergy. Additionally, reactivity with blotted hymenoptera venoms of a carbohydrate-specific rabbit antiserum against OSR pollen was investigated. Results Major venom glycoallergens binding with carbohydrate-specific human IgE and rabbit IgG were detected in HB venom at 42 (hyaluronidase (HYA)), 46, 65 and 95 kDa, and in YJ venom at 38 and 43 kDa (HYA). Antibody binding to these allergens was completely lost after periodate treatment. Glycans of HB phospholipase were bound by patients' IgE only after protein denaturation. In 10 of the 15 patients the reactivity was with the second venom because of carbohydrates alone. The high-molecular-weight glycoallergens identified in HB venom probably correspond to similar proteins described earlier, including allergens B and C. The 38-kDa YJ allergen might represent a homologue of V mac 3. Conclusions The data confirm the proposed role of carbohydrate-specific IgE in double positivity to HB and YJ venom and shed new light on some previously described minor hymenoptera allergens of uncertain clinical significance. The consideration of carbohydrate-specific IgE may allow to discriminate between patients with potentially relevant and patients with non-relevant double sensitization.
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antibody binding to venom carbohydrates is a frequent cause for double positivity to honeybee and yellow jacket venom in patients with stinging Insect Allergy
The Journal of Allergy and Clinical Immunology, 2001Co-Authors: Wolfgang Hemmer, Margarete Focke, Daniel Kolarich, Iain B H Wilson, Friedrich Altmann, Stefan Wohrl, M Gotz, R JarischAbstract:Background: Up to 50% of patients with stinging-Insect Allergy have double-positive RAST results to honeybee and yellow jacket (YJ) venom. True double sensitization and crossreactivity through venom hyaluronidases are considered main reasons for this multiple reactivity. Objective: We investigated the role of antibodies against crossreactive carbohydrate determinants in venom double positivity. Methods: CAP inhibition experiments were performed with crude oilseed rape (OSR) and timothy grass pollen extracts and a neoglycoprotein construct displaying a MUXF glycan, as present in pineapple-stem bromelain (MUXF-BSA). CAP to OSR was used as a rough measure for carbohydrate-specific IgE in individual sera. Results: CAP results to OSR pollen were positive in 2 of 14 single-positive honeybee venom sera, 2 of 16 single-positive YJ venom sera, and 33 (80.5%) of 41 double-positive sera (P CAP score to second venom), pollen extracts, MUXF-BSA, or both were able to completely inhibit IgE binding to one of the venoms, whereas this was not the case in 5 patients with a negative or weakly positive CAP result to OSR (CAP score to OSR < CAP score to second venom). Conclusions: The data suggest that carbohydrate-specific IgE is a major cause for the double positivity to honeybee and YJ venom seen in patients with Hymenoptera Allergy. Because these antibodies may have low clinical relevance, they may severely impede the correct diagnosis of Hymenoptera venom Allergy. (J Allergy Clin Immunol 2001;108:1045-52.)