Cellular in vitro Assays in the Diagnosis of Hymenoptera Venom Allergy
Background: The current diagnostic procedures of anaphylactic reactions to hymenoptera stings include intradermal tests, venom-specific IgE (sIgE) and possibly sting challenge tests. Sometimes, the culprit insect remains unidentified. The usefulness of the cellular assays CAST®-ELISA and Flow-CAST®...
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| Veröffentlicht in: | International archives of allergy and immunology 2008-01, Vol.146 (2), p.122-132 |
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| creator | Scherer, K. Weber, J.M. Jermann, T.M. Krautheim, A. Tas, E. Ueberschlag, E.V. Cammarata, M. Bircher, A.J. |
| description | Background: The current diagnostic procedures of anaphylactic reactions to hymenoptera stings include intradermal tests, venom-specific IgE (sIgE) and possibly sting challenge tests. Sometimes, the culprit insect remains unidentified. The usefulness of the cellular assays CAST®-ELISA and Flow-CAST® in the management of hymenoptera venom allergy was investigated. Methods: 134 patients with systemic reactions after a yellow jacket wasp and/or honey bee sting and 44 healthy controls underwent skin tests, as well as determination of sIgE (CAP-FEIA), leukocyte sulfidoleukotriene release (CAST-ELISA) and basophil CD63 expression (Flow-CAST) upon insect venom stimulation. The clinical diagnosis based on the history alone served as reference. Sensitivity, specificity, and positive and negative predictive value of all methods were compared. Concordance and correlations among methods were calculated. Results: Sensitivity and specificity of all in vitro tests were consistently high. The combination of all tests (skin tests, sIgE, combined cellular assays) yielded a positive predictive value of 100% for both venoms, if all 3 were positive, and a negative predictive value of 100%, if at least 1 test was positive. Relative specificities were considerably higher for the cellular assays (honey bee: CAST 91.1%, Flow-CAST 85.7%; yellow jacket wasp: CAST 98.4%, Flow-CAST 92.1%) and allow the detection of the culprit insect in patients with reactivity to both insects. The concordance between methods was good. There is no correlation between severity of clinical reaction and cellular assays. Conclusion: CAST-ELISA and Flow-CAST are valuable additional diagnostic tools for establishing the true culprit insect in patients with unclear clinical history or sensitization to both insects. |
| doi_str_mv | 10.1159/000113515 |
| format | Article |
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Sometimes, the culprit insect remains unidentified. The usefulness of the cellular assays CAST®-ELISA and Flow-CAST® in the management of hymenoptera venom allergy was investigated. Methods: 134 patients with systemic reactions after a yellow jacket wasp and/or honey bee sting and 44 healthy controls underwent skin tests, as well as determination of sIgE (CAP-FEIA), leukocyte sulfidoleukotriene release (CAST-ELISA) and basophil CD63 expression (Flow-CAST) upon insect venom stimulation. The clinical diagnosis based on the history alone served as reference. Sensitivity, specificity, and positive and negative predictive value of all methods were compared. Concordance and correlations among methods were calculated. Results: Sensitivity and specificity of all in vitro tests were consistently high. The combination of all tests (skin tests, sIgE, combined cellular assays) yielded a positive predictive value of 100% for both venoms, if all 3 were positive, and a negative predictive value of 100%, if at least 1 test was positive. Relative specificities were considerably higher for the cellular assays (honey bee: CAST 91.1%, Flow-CAST 85.7%; yellow jacket wasp: CAST 98.4%, Flow-CAST 92.1%) and allow the detection of the culprit insect in patients with reactivity to both insects. The concordance between methods was good. There is no correlation between severity of clinical reaction and cellular assays. Conclusion: CAST-ELISA and Flow-CAST are valuable additional diagnostic tools for establishing the true culprit insect in patients with unclear clinical history or sensitization to both insects.</description><identifier>ISSN: 1018-2438</identifier><identifier>EISSN: 1423-0097</identifier><identifier>DOI: 10.1159/000113515</identifier><identifier>PMID: 18204278</identifier><language>eng</language><publisher>Basel, Switzerland: Karger</publisher><subject>Adolescent ; Adult ; Aged ; Allergies ; Animals ; Apis mellifera ; Basophils - immunology ; Basophils - pathology ; Bee Venoms - immunology ; Biological and medical sciences ; Cells, Cultured ; Child ; Diagnostic tests ; Female ; Fundamental and applied biological sciences. Psychology ; Fundamental immunology ; Humans ; Hymenoptera ; Hymenoptera - immunology ; Hypersensitivity, Immediate - diagnosis ; Hypersensitivity, Immediate - immunology ; Hypersensitivity, Immediate - pathology ; Hypersensitivity, Immediate - therapy ; Immunity, Cellular ; Immunoglobulins ; Immunopathology ; Insect bites ; Insect Bites and Stings - immunology ; Insect Bites and Stings - pathology ; Insect Bites and Stings - therapy ; Male ; Medical sciences ; Middle Aged ; Original Paper ; Predictive Value of Tests ; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis ; Wasp Venoms - immunology</subject><ispartof>International archives of allergy and immunology, 2008-01, Vol.146 (2), p.122-132</ispartof><rights>2008 S. Karger AG, Basel</rights><rights>2008 INIST-CNRS</rights><rights>(c) 2008 S. Karger AG, Basel.</rights><rights>Copyright (c) 2008 S. Karger AG, Basel</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c392t-3aa6ac2b128f45f41b65c70d805d46697d32a08e1d922cb0dd03d9269eaae08d3</citedby><cites>FETCH-LOGICAL-c392t-3aa6ac2b128f45f41b65c70d805d46697d32a08e1d922cb0dd03d9269eaae08d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,2422,27903,27904</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20326085$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18204278$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Scherer, K.</creatorcontrib><creatorcontrib>Weber, J.M.</creatorcontrib><creatorcontrib>Jermann, T.M.</creatorcontrib><creatorcontrib>Krautheim, A.</creatorcontrib><creatorcontrib>Tas, E.</creatorcontrib><creatorcontrib>Ueberschlag, E.V.</creatorcontrib><creatorcontrib>Cammarata, M.</creatorcontrib><creatorcontrib>Bircher, A.J.</creatorcontrib><title>Cellular in vitro Assays in the Diagnosis of Hymenoptera Venom Allergy</title><title>International archives of allergy and immunology</title><addtitle>Int Arch Allergy Immunol</addtitle><description>Background: The current diagnostic procedures of anaphylactic reactions to hymenoptera stings include intradermal tests, venom-specific IgE (sIgE) and possibly sting challenge tests. Sometimes, the culprit insect remains unidentified. The usefulness of the cellular assays CAST®-ELISA and Flow-CAST® in the management of hymenoptera venom allergy was investigated. Methods: 134 patients with systemic reactions after a yellow jacket wasp and/or honey bee sting and 44 healthy controls underwent skin tests, as well as determination of sIgE (CAP-FEIA), leukocyte sulfidoleukotriene release (CAST-ELISA) and basophil CD63 expression (Flow-CAST) upon insect venom stimulation. The clinical diagnosis based on the history alone served as reference. Sensitivity, specificity, and positive and negative predictive value of all methods were compared. Concordance and correlations among methods were calculated. Results: Sensitivity and specificity of all in vitro tests were consistently high. The combination of all tests (skin tests, sIgE, combined cellular assays) yielded a positive predictive value of 100% for both venoms, if all 3 were positive, and a negative predictive value of 100%, if at least 1 test was positive. Relative specificities were considerably higher for the cellular assays (honey bee: CAST 91.1%, Flow-CAST 85.7%; yellow jacket wasp: CAST 98.4%, Flow-CAST 92.1%) and allow the detection of the culprit insect in patients with reactivity to both insects. The concordance between methods was good. There is no correlation between severity of clinical reaction and cellular assays. Conclusion: CAST-ELISA and Flow-CAST are valuable additional diagnostic tools for establishing the true culprit insect in patients with unclear clinical history or sensitization to both insects.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Allergies</subject><subject>Animals</subject><subject>Apis mellifera</subject><subject>Basophils - immunology</subject><subject>Basophils - pathology</subject><subject>Bee Venoms - immunology</subject><subject>Biological and medical sciences</subject><subject>Cells, Cultured</subject><subject>Child</subject><subject>Diagnostic tests</subject><subject>Female</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Fundamental immunology</subject><subject>Humans</subject><subject>Hymenoptera</subject><subject>Hymenoptera - immunology</subject><subject>Hypersensitivity, Immediate - diagnosis</subject><subject>Hypersensitivity, Immediate - immunology</subject><subject>Hypersensitivity, Immediate - pathology</subject><subject>Hypersensitivity, Immediate - therapy</subject><subject>Immunity, Cellular</subject><subject>Immunoglobulins</subject><subject>Immunopathology</subject><subject>Insect bites</subject><subject>Insect Bites and Stings - immunology</subject><subject>Insect Bites and Stings - pathology</subject><subject>Insect Bites and Stings - therapy</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Original Paper</subject><subject>Predictive Value of Tests</subject><subject>Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. 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Psychology</topic><topic>Fundamental immunology</topic><topic>Humans</topic><topic>Hymenoptera</topic><topic>Hymenoptera - immunology</topic><topic>Hypersensitivity, Immediate - diagnosis</topic><topic>Hypersensitivity, Immediate - immunology</topic><topic>Hypersensitivity, Immediate - pathology</topic><topic>Hypersensitivity, Immediate - therapy</topic><topic>Immunity, Cellular</topic><topic>Immunoglobulins</topic><topic>Immunopathology</topic><topic>Insect bites</topic><topic>Insect Bites and Stings - immunology</topic><topic>Insect Bites and Stings - pathology</topic><topic>Insect Bites and Stings - therapy</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Original Paper</topic><topic>Predictive Value of Tests</topic><topic>Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis</topic><topic>Wasp Venoms - immunology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Scherer, K.</creatorcontrib><creatorcontrib>Weber, J.M.</creatorcontrib><creatorcontrib>Jermann, T.M.</creatorcontrib><creatorcontrib>Krautheim, A.</creatorcontrib><creatorcontrib>Tas, E.</creatorcontrib><creatorcontrib>Ueberschlag, E.V.</creatorcontrib><creatorcontrib>Cammarata, M.</creatorcontrib><creatorcontrib>Bircher, A.J.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>ProQuest - Health & Medical Complete保健、医学与药学数据库</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biological Sciences</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest research library</collection><collection>Biological Science Database</collection><collection>Research Library (Corporate)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><jtitle>International archives of allergy and immunology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Scherer, K.</au><au>Weber, J.M.</au><au>Jermann, T.M.</au><au>Krautheim, A.</au><au>Tas, E.</au><au>Ueberschlag, E.V.</au><au>Cammarata, M.</au><au>Bircher, A.J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cellular in vitro Assays in the Diagnosis of Hymenoptera Venom Allergy</atitle><jtitle>International archives of allergy and immunology</jtitle><addtitle>Int Arch Allergy Immunol</addtitle><date>2008-01-01</date><risdate>2008</risdate><volume>146</volume><issue>2</issue><spage>122</spage><epage>132</epage><pages>122-132</pages><issn>1018-2438</issn><eissn>1423-0097</eissn><abstract>Background: The current diagnostic procedures of anaphylactic reactions to hymenoptera stings include intradermal tests, venom-specific IgE (sIgE) and possibly sting challenge tests. Sometimes, the culprit insect remains unidentified. The usefulness of the cellular assays CAST®-ELISA and Flow-CAST® in the management of hymenoptera venom allergy was investigated. Methods: 134 patients with systemic reactions after a yellow jacket wasp and/or honey bee sting and 44 healthy controls underwent skin tests, as well as determination of sIgE (CAP-FEIA), leukocyte sulfidoleukotriene release (CAST-ELISA) and basophil CD63 expression (Flow-CAST) upon insect venom stimulation. The clinical diagnosis based on the history alone served as reference. Sensitivity, specificity, and positive and negative predictive value of all methods were compared. Concordance and correlations among methods were calculated. Results: Sensitivity and specificity of all in vitro tests were consistently high. The combination of all tests (skin tests, sIgE, combined cellular assays) yielded a positive predictive value of 100% for both venoms, if all 3 were positive, and a negative predictive value of 100%, if at least 1 test was positive. Relative specificities were considerably higher for the cellular assays (honey bee: CAST 91.1%, Flow-CAST 85.7%; yellow jacket wasp: CAST 98.4%, Flow-CAST 92.1%) and allow the detection of the culprit insect in patients with reactivity to both insects. The concordance between methods was good. There is no correlation between severity of clinical reaction and cellular assays. Conclusion: CAST-ELISA and Flow-CAST are valuable additional diagnostic tools for establishing the true culprit insect in patients with unclear clinical history or sensitization to both insects.</abstract><cop>Basel, Switzerland</cop><pub>Karger</pub><pmid>18204278</pmid><doi>10.1159/000113515</doi><tpages>11</tpages></addata></record> |
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| subjects | Adolescent Adult Aged Allergies Animals Apis mellifera Basophils - immunology Basophils - pathology Bee Venoms - immunology Biological and medical sciences Cells, Cultured Child Diagnostic tests Female Fundamental and applied biological sciences. Psychology Fundamental immunology Humans Hymenoptera Hymenoptera - immunology Hypersensitivity, Immediate - diagnosis Hypersensitivity, Immediate - immunology Hypersensitivity, Immediate - pathology Hypersensitivity, Immediate - therapy Immunity, Cellular Immunoglobulins Immunopathology Insect bites Insect Bites and Stings - immunology Insect Bites and Stings - pathology Insect Bites and Stings - therapy Male Medical sciences Middle Aged Original Paper Predictive Value of Tests Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis Wasp Venoms - immunology |
| title | Cellular in vitro Assays in the Diagnosis of Hymenoptera Venom Allergy |
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