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Artículo de Revisión

Alergia al veneno de himenópteros

Carolina Díaz Gallardo, María Angélica Marinovic Mayorga, Jessica Salinas Luypaert 2

ARCHIVOS DE ALERGIA E INMUNOLOGÍA CLÍNICA 2008;(2):0064-0073 

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La alergia al veneno de himenópteros es un hecho epidemiológicamente signifi cativo. Alrededor del 0,15% al 3% de la población general tiene historia de reacciones sistémicas causada por picaduras de insectos. Entre los himenópteros más comunes que provocan este tipo de reacciones se encuentran: abejas, abejorros, avispas y hormigas. Las manifestaciones clínicas varían desde reacciones locales (eritema, edema, prurito o dolor) hasta reacciones sistémicas, e incluso shock anafi láctico con riesgo vital. El manejo inmediato depende de la intensidad de la reacción y abarca desde la aplicación de frío local y el uso de antihistamínicos orales y corticoides tópicos u orales hasta, en los casos más severos, la administración de adrenalina inyectable. En relación con el tratamiento a largo plazo, la inmunoterapia específi ca ha demostrado ser muy efectiva en la reducción del riesgo de reacción severa frente a la posterior picadura de insecto.


Palabras clave: alergia, veneno, himenópteros, cuadro clínico, diagnóstico, tratamiento,

Th e diagnosis of Hymenoptera venom allergy is a signifi cant epidemiological issue. Among 0.15% to 3% of the general population has a history of systemic allergic reactions caused by an insect sting. Hymenoptera that cause this type of reactions are bees, bumblebees, wasps and ants. Th e clinical manifestations vary from local reactions (redness, swelling, pruritus and/or pain) to systemic reactions, and even anaphylactic shock. Th e immediate management depends on the intensity of the reaction. It includes the application of local cold, antihistamines, oral or topical glucocorticosteroids and, in severe cases, an intramuscular or subcutaneous injection of epinephrine. Th e specifi c immunotherapy has demonstrated to be very eff ective in reducing the risk of severe reaction following a new Hymenoptera sting.


Keywords: allergy, venom, hymenoptera, clinical manifestations, diagnosis,


Los autores declaran no poseer conflictos de intereses.

Fuente de información Asociación Argentina de Alergia e Inmunología Clínica. Para solicitudes de reimpresión a Archivos de Alergia e Inmunología Clínica hacer click aquí.

Recibido | Aceptado | Publicado 2008-07-01

  1. Peláez A, Alonso E. Alergia a venenos de himenópteros. En: Roberto Pelta y Mar Gandolfo, Guía de alergia para residentes y atención primaria. Madrid: Ediciones Díaz de Santos S.A.; 2001. Capítulo 14, pp. 207-223.

  2. Gruchalla R. Immunotheraphy in allergy to insect sting in children. N Engl J Med 2004;351:707-709.

  3. Graft D. Insect sting allergy. Med Clin N Am 2006;90:211-232.

  4. Biló B, Rueff F, Mosbech H, Bonifazi F, Oude-Elberlink J. Diagnosis of hymenoptera venom allergy. Allergy 2005;60:1339-1349.

  5. Mosbech H. Death caused by wasp and bee stings in Denmark 1960-1980. Allergy 1983;38:195-200.

  6. Sasvari T, Muller U. Fatalities from insect stings in Switzerland 1978 to 1987. Schweiz Med Wochenschr 1994;124:1887-1894.

  7. Incorvaia C, Mauro M, Pastorello EA. Hymenoptera stings in conscripts. Allergy 1997;52:680-681.

  8. Grigoreas Ch, Galatas ID, Kiamouris Ch, Papaioannou D. Insect venom allergy in Greek adults. Allergy 1997;52:51-57.

  9. Fernández J, Blanca M, Soriano J, Sánchez J, Juárez C. Epidemiological study of the prevalence of allergic reactions to Hymenoptera in a rural population in the Mediterranean area. Clin Exp Allergy 1999;29:1069-1074.

  10. Novembre E, Cianferoni A, Bernardini RA, Ingargiola A, Lombardi E, Vierucci A. Epidemiology of insect venom sensitivity in children and its correlation to clinical and atopic features. Clin Exp Allergy 1998;28:834-838.

  11. de la Torre-Morin F, García-Robaina JC, Vázquez-Moncholi C, Fierro J, Bonnet-Moreno C. Epidemiology of allergic reactions in beekeepers: a lower prevalence in subjects with more than 5 years exposure. Allergol Immunopathol (Madr) 1995;23:127-132.

  12. Annila IT, Karjalainen ES, Annila PA, et al. Bee and wasp sting reactions in current beekeepers. Ann Allergy Asthma Immunol 1996;77:423-427.

  13. Lockey R, Turkelstaub P, Baird- Warren I, et al. Th e hymenoptera venom study I, 1979-1982: demographics and history data. J Allergy Clin Immunol 1988;82:370-381.

  14. Chinery M. A fi eld guide to the insects of Britain and Northern Europe. London, UK: William Collins Sons & Co. Ltd.; 1984.

  15. Schwartz HJ, Sutheimer C, Gauerke MB, Yunginger JW. Hymenoptera venom-specifi c IgE antibodies in post-mortem sera from victims of sudden, unexpected death. Clin Allergy 1988;18:461-468.

  16. Armisén M, Vidal C, López-Carballoa C, Purriñosa M, Fernández-Ovide E, Piñeiro J. Alergia a veneno de himenópteros: epidemiología del área sanitaria de Santiago de Compostela. Alergol Inmunol Clin 2001;16:213-216.

  17. King TP, Spangfort MD. Structure and biology of stinging insect venom allergens. Int Arch Allergy Immunol 2000;123:99-106.

  18. Kettner A, Hughes GJ, Frutiger S, Astori M, Roggero M, Spertini F, et al. Api m 6: a new bee venom allergen. J Allergy Clin Immunol 2001;107:914-920.

  19. Freeman T. Hypersensitivity to hymenoptera stings. NEJM 2004;351:1978-1984.

  20. Birnbaum J, Vervloet D. Allergie aux piqûres d’hyménopterès. En: Vervloet D, Magnan A. Traité d’ allergologie. Paris: Edit Flammarion; 2003. Cap 60, pp. 867-884.

  21. Muller U. Recombinant venom allergens. Allergy 2002;57:570-576.

  22. Owen MD, Pfaff LA, Reisman RE, Wypych J. Phospholipase A2 in venom extracts from honey bees (Apis mellifera L.) of diff erent ages. Toxicol 1990; 28:813-820.

  23. Habermann E. Bee and wasp venoms. Science 1972;177:314-322.

  24. Markovic-Housley Z, Miglierini G, Soldatova L, Rizkallah PJ, Muller U, Schirmer T. Crystal structure of hyaluronidase, a major allergen of bee venom. Structure Fold Des 2000;15:1025-1035.

  25. King TP, Alagon AC, Kuan J, Sobotka AF, Lichtenstein LM. Immunochemical studies of yellow jacket venom proteins. Mol Immunol 1983;20: 297-308.

  26. Henriksen A, King TP, Mirza O, Monsalve RI, Meno K, Ipsen H, et al. Major venom allergen of yellow jackets, Ves v 5: structural characterization of a pathogenesis-related protein superfamily. Proteins 2001;45:438-448.

  27. Venegas O. Hipersensibilidad a venenos de himenópteros. En: M Antonieta Guzmán. Alergias, Guía clínica. Editorial Mediterráneo; 2004. Cap 9, pp. 165-174.

  28. Jorro Martinez G, Brasó Aznar JV. Alergia al veneno de himenópteros. En: Manual de Alergia Clínica. Editorial Masson; 2003. Cap 32, pp. 521-531.

  29. Hemmer W, Focke M, Kolarich D, Wilson IB, Altmann F, Wohrl S, et al. Antibody binding to venom carbohydrates is a frequent cause for double positivity to honeybee and yellow jacket venom in patients with stinging insect allergy. J Allergy Clin Immunol 2001;108:1045-1052.

  30. Nelson DR, Collins AM, Hellmich RL, Jones RT, Helm RM, Squillace DL, et al. Biochemical and immunochemical comparison of Africanized and European honeybee venoms. J Allergy Clin Immunol 1990;85:80-85.

  31. Schumacher MJ, Schmidt JO, Egen NB, Lowry JE. Quantity, analysis, and lethality of European and Africanized honey bee venoms. Am J Trop Med Hyg 1990;43:79-86.

  32. Hoff man DR, Jacobson RS. Allergens in Hymenoptera venom: XXVII. Bumblebee venom allergy and allergens. J Allergy Clin Immunol 1996;97: 812-821.

  33. Stapel SO, Waanders-Lijster Raadt de J, van Toorenenbergen AW, de Groot H. Allergy to bumblebee venom: II. IgE cross-reactivity between bumblebee and honeybee venom. Allergy 1998;53:769-777.

  34. Bucher C, Korner P, Wüthrich B. Allergy to bumblebee venom. Curr Opin Allergy Clin Immunol 2001;1:361-365.

  35. Hoff man DR. Allergens in Hymenoptera venom: XXV. Th e amino acid sequences of antigen 5 molecules and the structural basis of antigenic crossreactivity. J Allergy Clin Immunol 1993;92:707-716.

  36. King TP, Lu G, Gonzales M, Qian N, Soldatova L. Yellow jacket venom allergens, hyaluronidase and phospholipase. Sequence similarity and antigenic cross-reactivity with hornet and wasp homologs and possible implications for clinical allergy. J Allergy Clin Immunol 1996;98:588-600.

  37. Panzani R, Blanca M, Sanchez F, Juarez C. Sensitivity to European wasps in a group of allergic patients in Marseille: preliminary results. J Investig Allergol Clin Immunol 1994;4:42-46.

  38. Pantera B, Hoff man DR, Carresi L, Cappugi G, Turillazzi S, Manao G, et al. Characterization of the major allergens purifi ed from the venom of the paper wasp Polistes gallicus. Biochim Biophys Acta 2003;1623:72-81.

  39. Golden D. Insect sting allergy and venom immunotheraphy: A model and a mystery. JACI 2005;115:439-447.

  40. Johansson SGO, Hourihane JO, Bousquet J, Bruijnzeel-Koomen C, Dreborg S, Haahtela T, et al. A revised nomenclature for allergy. An EAACI position statement from the EAACI nomenclature task force. Allergy 2001; 56:813-824.

  41. Ellis A, Day J. Clinical reactivity to insect stings. Curr Opin Allergy Clin Immunol 2005;5:349-354.

  42. Moffi tt JE, Golden DBK, Reisman RE, et al. Stinging insect hypersensitivity: a practice parameter update. J Allergy Clin Immunol 2004;114:869-886.

  43. Rueff F, Przybilla B. Venom immunotherapy: adverse reactions and treatment failure. Curr Opin Allergy Clin Immunol 2004; 4: 307-11.

  44. Muller UR. Insect sting allergy.Stuttgart, Germany: Gustav Fischer, 1990.

  45. Mueller HL. Diagnosis and treatment of insect sensitivity. J Asthma Res 1966;3:331-333.

  46. Ring J, Messmer K. Incidence and severity of anaphylactoid reactions to colloid volume substitutes. Lancet 1977;1(8009):466-469.

  47. Ellis AK, Day JH. Diagnosis and management of anaphylaxis. CMAJ 2003;169:307-312.

  48. Solley GO. Stinging and biting insect allergy: an Australian experience. Ann Allergy Asthma Immunol 2004;93:532-537.

  49. Stark BJ, Sullivan TJ. Biphasic and protracted anaphylaxis. J Allergy Clin Immunol 1986;78:76-83.

  50. Ellis AK, Day JH. A prospective evaluation of 103 patients with biphasic anaphlyaxis [abstract 935]. J Allergy Clin Immunol 2004;113:S259.

  51. Reisman R. Unusual reactions to insect stings. Curr Opin Allergy Clin Immunol 2005;5:355-358.

  52. Pucci S, Antonicelli L, Bilo MB, Garritani MS, Bonifazi F. Th e short interval between two stings as a risk factor for developing Hymenoptera venom allergy. Allergy 1994;49:894-896.

  53. Golden DBK, Marsh DG, Freidhoff LR, Kwiterovich KA, Addison B, Kagey-Sobotka A, Lichtenstein LM. Natural history of Hymenoptera venom sensitivity in adults. J Allergy Clin Immunol 1997;100:760-766.

  54. Annila IT, Annila PA, Morsky P. Risk assessment in determining systemic reactivity to honeybee stings in beekeepers. Ann Allergy Asthma Immunol 1997;78:473-477.

  55. Valentine MD, Schuberth KC, Kagey-Sobotka A, Graft DF,Kwiterovich KA, Szklo M, Lichtenstein LM. Th e value of immunotherapy with venom in children with allergy to insect stings. N Engl J Med 1990;323:1601.

  56. Engel T, Heinig JH, Weeke ER. Prognosis of patients reacting with urticaria to insect sting. Results of an in-hospital sting challenge. Allergy 1988; 43:289-293.

  57. Reisman RE. Natural history of insect sting allergy: relationship of severity of symptoms of initial sting anaphylaxis to re-sting reactions. J Allergy Clin Immunol 1992;90:335-339.

  58. Chipps BE, Valentine MD, Kagey-Sobotka A, Schuberth KC, Lichtenstein LM. Diagnosis and treatment of anaphylactic reactions to Hymenoptera stings in children. J Pediatr 1980;97:177-184.

  59. Lockey RF, Turkeltaub PC, Baird-Warren IA, Olive CA, Olive ES, Peppe BC, et al. Th e Hymenoptera venom study I, 1979–1982: demographics and history-sting data. J Allergy Clin Immunol 1988;82:370-381.

  60. Lantner R, Reisman RE. Clinical and immunologic features and subsequent course of patients with severe insect sting anaphylaxis. J Allergy Clin Immunol 1989;84:900-906.

  61. Franken HH, Dubois AE, Minkema HJ, van der Heide S, de Monchy JG. Lack of reproducibility of a single negative sting challenge response in the assessment of anaphylactic risk in patients with suspected yellow jacket hypersensitivity. J Allergy Clin Immunol 1994;93:431-436.

  62. Dubois A. Mastocytosis and hymenoptera allergy. Curr Opin Allergy Immunol 2004;4:291-295.

  63. Goldberg A, Confi no-Cohen R. Timing of venom skin tests and IgE determinations after insect sting anaphylaxis. J Allergy Clin Immunol 1997;100:182-184.

  64. Rueff F, Werfel S, Przybilla B. Change of the serum concentration of Hymenoptera venomspecifi c IgE antibodies after a systemic sting reaction – a possible diagnostic tool? Allergy 2003;58(Suppl. 74):99 [abstract].

  65. Annila I, Hurme M, Miettinen A, Kuusisto P, Nieminen MM. Lymphocyte subpopulations, cytokine release and specifi c immunoglobulin G in reactive and nonreactive beekeepers. J Investig Allergol Clin Immunol 1998;8:109-114.

  66. Ludolph-Hauser D, Rueff F, Fries C, Schopf P, Przybilla B. Constitutively raised serum concentrations of mast-cell tryptase and severe anaphylactic reactions to Hymenoptera stings. Lancet 2001;357:361-362.

  67. Dubois AE. Investigational and clinical use of the sting challenge. Curr Opin Allergy Clin Immunol 2003;3:283-285.

  68. Hamilton R. Diagnostic methods for insect sting allergy. Curr Opin Allergy Clin Immunol 2004;4:297-306.

  69. Golden D, Kagey-Sobotka A, Norman P, Hamilton R, Lichtenstein L. Insect sting allergy with negative venom skin test responses. J Allergy Clin Immunol 2001;107:897-901.

  70. Lambert C, Guilloux L, Dzviga C, et al. Flow cytometry versus histamine release analysis of in vitro basophil degranulation in allergy to Hymenoptera venom. Cytometry 2003;52B:13-19.

  71. Binder M, Fierlbeck G, King TP, et al. Individual hymenoptera venos compounds induce up regulation of the basophil activation marker ectonucleotide pyrophosphatase/phosphodiesterase 3 (CD203c) in sensitized patients. Int Arch Allergy Immunol 2002;129:160-168.

  72. Platz IJ, Binder M, Marxer A, et al. Hymenoptera venom induced upregulation of the basophil activation marker ecto-nucleotidepyrophosphatase/phosphodiesterase 3 in sensitized individuals. Int Arch Allergy Immunol 2001;126:335-342.

  73. Eberlein-Konig B, Varga R, Mempel M, Darsow U, Behrendt H, Ring J. Comparison of basophil activation tests using CD63 or CD203c expresión in patients with insect venom allergy. Allergy 2006;61:1084-1085.

  74. Hunt V, Sobokta A. Diagnosis of allergy to stinging insects by skin testing with hymenoptera venons. Ann Intern Med 1976;85:56-59.

  75. Graft D. Never say never: exchange of comments on negative VST responses. JACI 2001;108:875-876.

  76. Ewan P. Mew insight into immunological mechanism of venom immunotherapy. Curr Opin Allergy Clin Immunol 2001;1:367-374.

  77. Jutel M, Akdis M, Blaser K, Akdis C. Are regulatory T cells the target of venom immunotherapy? Curr Opin Allergy Clin Immunol 2005;5:365-369.

  78. Amsen D, Blander JM, Lee GR, et al. Instruction of distinct CD4 T helper cell fates by diff erent notch ligands on antigen-presenting cells. Cell 2004;117:515-526.

  79. Akdis CA, Blesken T, Akdis M, et al. Role of interleukin 10 in specifi c immunotherapy. J Clin Invest 1998;102:98-106.

  80. McHugh SM, Deighton J, Stewart AG, et al. Bee venom immunotherapy induces a shift in cytokine responses from a TH-2 to a TH-1 dominant pattern: comparison of rush and conventional immunotherapy. Clin Exp Allergy 1995;25:828-838.

  81. Smits HH, van Rietschoten JGI, Hilkens CMU, et al. IL-12 induced reversal of human TH2 cells is accompanied by full restoration of IL-12 responsiveness and loss of GATA-3 expression. Eur J Immunol 2001;31:1055-1065.

  82. Birnbaum J, Charpin D, Vervloet D. Rapid Hymenoptera venom immunotherapy: comparative safety of three protocols. Clin Exp Allergy 1993;23:226-230.

  83. Bernstein JA, Kagan SL, Bernstein DI, Bernstein IL. Rapid venom immunotherapy is safe for routine use in the treatment of patients with Hymenoptera anaphylaxis. Ann Allergy 1994;73:423-428.

  84. Graft DF, Golden DBK, Reisman RE, Valentine MD, Yunginger JW. The discontinuation of Hymenoptera venom immunotherapy. Report from the Committee on Insects of the American Academy of Allergy Asthma and Immunology. J Allergy Clin Immunol 1998;101:573-575.

  85. Golden DBK, Kagey-Sobotka A, Lichtenstein LM. Survey of patients after discontinuing venom immunotherapy. J Allergy Clin Immunol 2000;105: 385-390.

  86. Scribner T, Bernstein D. Rapid venom immunotherapy update. Curr Opin Allergy Clin Immunol 2003;3:295-298.

  87. Muller U, Hari Y, Berchtold E. Premedication with antihistamines may enhance efficacy of specific-allergen immunotherapy. J Allergy Clin Immunol 2001;107:81-86. 

  88. Schwartz H, Golden D, Lockey R. Venom immunotherapy in the hymenoptera-allergic pregnant patient. JACI 1990;85:709-712.

  89. Graft D. Immunotherapy during pregnancy. Allergy Proc 1988; 9: 563-565.

Autores

Carolina Díaz Gallardo
Médico residente Inmunología Clínica, sección de Inmunología, Hospital Clínico Universidad de Chile.
María Angélica Marinovic Mayorga
Centro de Alergias, Sección Inmunología y Alergología , Hospital Clínico Universidad de Chile..
Jessica Salinas Luypaert 2
Centro de Alergias, Sección Inmunología y Alergología , Hospital Clínico Universidad de Chile..

Autor correspondencia

María Angélica Marinovic Mayorga
Centro de Alergias, Sección Inmunología y Alergología , Hospital Clínico Universidad de Chile..

Correo electrónico: mamarinovic@gmail.com

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Archivos de Alergia e Inmunología Clínica
Número 2 | Volumen 39 | Año 2008

Titulo
Alergia al veneno de himenópteros

Autores
Carolina Díaz Gallardo, María Angélica Marinovic Mayorga, Jessica Salinas Luypaert 2

Publicación
Archivos de Alergia e Inmunología Clínica

Editor
Asociación Argentina de Alergia e Inmunología Clínica

Fecha de publicación
2008-07-01

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