Observations on the aetiology and natural history of stinging insect sensitivity: application of measurements of venom‐specific IgE

Abstract

Summary Measurements of serum venom specific IgE were used to gain further insight into the aetiology and natural history of stinging insect allergy. Several aspects were studied. (a) Following sting reactions, sequential sera were examined in the absence of venom immunotherapy. There was a marked individual patient variation in the persistence of venom specific IgE. In nine patients, antibody levels dropped to insignificant levels, suggesting the possibility that sensitivity can be lost spontaneously. (b) Details of four patients with anamnestic IgE antibody responses after sting reactions are presented. These responses occurred even when prior antibody titres were negligible, suggesting that patients mentioned above (No. 1) will require careful monitoring. The anamnestic responses are insect specific. (c) Eighteen patients were studied who had typical insect sting anaphylaxis and subsequent insignificant serum levels of venom specific IgE. One third also had negative direct skin tests with venom. These observations suggest that the possibility for a non‐IgE pathogenesis for some insect sting reactions may have to be considered. (d) One patient was identified who became sensitized to non‐venom protein in whole body insect extracts as the result of whole body extract therapy.