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Keywords: Basophil activation test nonresponders, Hymenoptera venom allergy, LAD2, mast cell activation test, reaction severity
Published in DiRROS: 07.08.2026; Views: 250; Downloads: 162
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Abstract: Introduction: Severe anaphylaxis in patients with clonal mast cell disorders highlights the need for proper use of adrenaline autoinjectors. This study assessed knowledge retention and adherence to autoinjector use in c-KIT p.D816V-positive individuals with hymenoptera venom allergy undergoing venom immunotherapy (VIT) and prescribed two autoinjectors. Methods: Seventy-one VIT patients received personalized autoinjector education, with knowledge assessed at 3, 4 to 12, 12 to 24, and > 24 months. Fifteen patients 5 years post-VIT underwent video-based retraining and were assessed 1 month later. Results: Knowledge retention was 82.3% at 3 months, dropping to 40.0% at 12 to 24 months (p = 0.0160) and 22.2% after 24 months (p = 0.0005), indicating a clear decline over time. Common errors included ignoring the safety cap (16.7%), insufficient injection force, finger injection risk, and upper arm activation (totaling 19.0%). In addition, 19.8% failed to hold the autoinjector in the muscle for 3 seconds, 26.9% did not know to lie supine during anaphylaxis, and 14.3% did not seek emergency help. In the video-retrained group, 80.0% lacked proficiency 1 month later, 73.3% were unaware of the second dose, and 66.7% did not carry their devices. Conclusions: Ongoing tailored education is essential to ensure effective autoinjector use, especially in c-KIT p.D816V-positive venom-allergic patients. Video instruction alone may be insufficient.
Keywords: Hymenoptera, autoinjector, patient education
Published in DiRROS: 09.01.2026; Views: 804; Downloads: 260
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Abstract: Understanding the risk factors leading to severe systemic sting reactions (SSRs) is crucial for initiating venom immunotherapy (VIT) and for educating affected individuals and their families. Some of these risk factors are well established, some are no longer considered risk factors, and some remain controversial. Well-established risk factors for severe SSRs include clonal mast cell disease, high baseline serum tryptase, and advanced age. The absence of skin symptoms and the rapid onset of symptoms are indicators of severe SSRs. Recent publications indicate that antihypertensive treatment and stings in the head and neck area are not risk factors for severe SSRs. VIT is the only available treatment that can potentially prevent further anaphylactic reactions. Although rare and generally manageable, individuals undergoing VIT may experience systemic adverse events (sAEs). More sAEs are expected in patients undergoing bee VIT compared with vespid VIT. The role of elevated baseline serum tryptase as a risk factor for sAEs remains debated, but if it is a factor, the risk is increased by only about 1.5-fold. Rapid updosing protocols, depending on the specific regimen, can also be associated with more sAEs. Severe initial SSRs, antihypertensive medication, high skin test reactivity, and high specific IgE levels are not risk factors for sAEs.
Keywords: immunology, anaphylaxis, Hymenoptera venom allergy, risk factors, severe systemic sting reactions, side effects, venom immunotherapy
Published in DiRROS: 02.07.2025; Views: 934; Downloads: 927
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Keywords: immunology, allergy to poison Hymenoptera, peripheral leukocytes, venom immunotherapy
Published in DiRROS: 19.02.2025; Views: 1211; Downloads: 883
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Abstract: Allergen-specific venom immunotherapy (VIT) is a well-established therapy for Hymenoptera venom allergy (HVA). However, the precise mechanism underlying its clinical effect remains uncertain. Our study aimed to identify the molecular mechanisms associated with VIT efficiency. We prospectively included 19 patients with HVA undergoing VIT (sampled before the beginning of VIT, after reaching the maintenance dose, one year after finishing VIT, and after a sting challenge) and 9 healthy controls. RNA sequencing of whole blood was performed on an Illumina sequencing platform. Longitudinal transcriptomic profiling revealed the importance of the inhibition of the NFκB pathway and the downregulation of DUX4 transcripts for the early protection and induction of tolerance after finishing VIT. Furthermore, successful treatment was associated with inhibiting Th2, Th17, and macrophage alternative signalling pathways in synergy with the inhibition of the PPAR pathway and further silencing of the Th2 response. The immune system became activated when reaching the maintenance dose and was suppressed after finishing VIT. Finally, successful VIT restores the immune system’s balance to a state similar to that of healthy individuals. Our results underline the important role of the inhibition of four pathways in the clinical effect of VIT: Th2, Th17, NFκB, and macrophage signalling. Two biomarkers specific for successful VIT, regardless of the time of sampling, were C4BPA and RPS10-NUDT3 and should be further tested as potential biomarkers.
Keywords: Hymenoptera venom immunotherapy, longitudinal transcriptomic profiling, tolerance induction, successful venom immunotherapy
Published in DiRROS: 19.02.2025; Views: 1065; Downloads: 720
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