Bee Allergy

Yıl 2017, Cilt: 9 Sayı: 2, 109 - 116, 15.03.2017

Doç. Dr. Yakup Canıtez

Öz

Abstract

Reactions to bee stings are include small local reactions, large local reactions, andsystemic (anaphylaxis) reactions. The most of sting reactions due to bee sting are common small local reaction. The large local reactions diameter is more than 10 cm. These reactions do not predispose to systemic reactions, but the risk of systemic reactions in patients with recurrent large local reactions is higher than in small local reactions. Diagnosis of bee allergy depends on history, skin tests and serum specific IgE levels. While the cross reaction between honey bee species is limited, it is frequent between vespula. The first step of the treatment is tell about prevention to beestings. Diagnosis and treatment of anaphylaxis due to bee sting is the same as anaphylaxis due to other causes. If patient have a systemic reaction story, adrenalin autoenjector should be prescribed and given training. Venom immunotherapy is a highly successful treatment method used in children with a systemic reaction risk after bee sting.

Anahtar Kelimeler

Bee allergy, anaphylaxis, Immunotherapy, Venom immunotherap

Arı Alerjisi

Öz

Öz

Arı sokmalarına bağlı reaksiyonlar; küçük lokal reaksiyonlar, geniş lokal reak-siyonlar ve sistemik (anafilaksi) reaksiyonlardır. Arı sokmalarına bağlı en sık küçüklokal reaksiyon görülür. Geniş lokal reaksiyon 10 cm çapından daha fazla genişlikte olan lezyonlardır. Bu reaksiyonlar sistemik reaksiyonların öncüsü değildir ancak tekrarlayan geniş lokal reaksiyonu olan hastalarda sistemik reaksiyon riski küçük lokal reaksiyona göre daha yüksektir. Arı alerjisinde tanı; öykü, deri testleri ve serumspesifik IgE düzeylerine bakılarak konulmaktadır. Bal arısı türleri arasında çapraz reaksiyon sınırlı iken, yaban arıları arasında sıktır. Tedavide ilk yapılması gereken arı sokmasından korunma önlemlerinin anlatılmasıdır. Arı sokmasına bağlı anafilaksinin tanı ve tedavisi diğer nedenlere bağlı anafilaksi ile aynıdır. Sistemik reaksiyon öyküsü olan hastalara adrenalin otoenjektörü reçete edilmeli ve kullanma eğitimi verilmelidir. Venom immünoterapisi arı sokması sonrası sistemik reaksiyon riski olan çocuklarda kullanılan ve başarı oranı yüksek bir tedavi yöntemidir.

Anahtar Kelimeler

immünoterapi, venom immünoterapi

Kaynakça

• Kaynaklar 1.Biló BM, Rueff F, Mosbech H, Bonifazi F, Oude-Elberink JN; EAA-CI Interest Group on Insect Venom Hypersensitivity. Diagnosis ofHymenoptera venom allergy. Allergy 2005;60(11):1339-49. 2.Krishna MT, Ewan PW, Diwakar L, et al. British Society for Allergyand Clinical Immunology. Diagnosis and management of hymenop-tera venom allergy: British Society for Allergy and Clinical Immu-nology (BSACI) guidelines. Clin Exp Allergy 2011;41(9):1201-20. 3.Mosbech H. Death caused by wasp and bee stings in Denmark, 1960-80. Allergy 1983; 38:195-200. 4.Harvey P, Sperber S, Kette F, Heddle RJ, Roberts-Thompson PJ. Bee-sting mortality in Australia. Med J Aust 1984; 140:209-11. 5.Golden DBK. Insect allergy. In: Adkinson NF, Bochner BS, Burks W,BusseWW, Holgate TS. et al., editors. Middleton’s allergy: princip-les and practice. 8th ed. Elsevier Health Sciences; 2013. p. 1260-73. 6.Yunginger JW. Insect Allergy. In: Middleton E Jr, Ellis EF, Yungin-ger JW et al (eds). Allergy, Principles & Practice. St Louis: Mosby-Year Book Inc.; 1998. 1063-72. 7.Müller U, Mosbech H. Position Paper: Immunotherapy with Hyme-noptera venoms. In: The European Academy of Allergology and Cli-nical Immunology (EAACI) Position papers. Allergy 1993; 48: 37-46. 8.Bousquet J, Menardo JL, Michel F. Allergies aux Hymenopteres. Jo-inville-le-pont: Institut Français de Recherche en Allergologie, 1985. 9.httpmark-lawton.combeekeeping-royal-jelly (web erişim tarihi25.04.2012). 10.httpen.wikipedia.orgwikiYellowjacket (web erişim tarihi 25.04.2012). 11. httpen.wikipedia.orgwikiPolistes dominula (web erişim tarihi25.04.2012). 12. Müller UR (ed). Insect sting allergy. Clinical Picture, diagnosis andtreatment. Stutgart, New York: Gustav Fischer Verlag; 1990. 13. Kalpaklıoğlu AF. Böcek Alerjisi. Astım Allerji İmmünoloji2003;1(1):44-53. 14. Reissman RE. Stinging Insect Allergy. Immunology and Allergy Cli-nics of North America 1992; 76:883-94. 15. deGroot H. Allergy to bumblebees. Curr Opin Allergy Clin Immu-nol 2006;6:294-7. 16. Greene A, Breisch NL, Golden DB, Kelly D, Douglass LW. Sting em-bedment and avulsion in yellowjackets (Hymenoptera: Vespidae): afunctional equivalent to autotomy. Am Ento¬mologist 2012;58:50-7. 17.King TP, Spangfort MD. Structure and biology of stinging insect ve-nom allergens. Int Arch Allergy Immunol 2000;123:99–106. 18.Hoffman DR, Jacobson RS. Allergens in Hymenoptera venom: XII.How much protein is in a sting? Ann Allergy 1984;52:276–278. 19.Jappe U, Raulf-Heimsoth M, Hoffmann M, Burow G, Hübsch-Mül-ler C, Enk A. In vitro Hymenoptera venom allergy diagnosis: impro-ved by screening for cross-reacting carbohydrate determinants andrecip¬rocal inhibition. Allergy 2006;61:1220-9. 20. Mitterman I, Zidarn M, Silar M, Markovic- Housley Z, Aberer W. Re-combinant allergen based IgE testing to distinguish bee and waspallergy. J Allergy Clin Immunol 2010;125: 1300-7. 21. Muller UR, Johansen N, Petersen AB, Fromberg-Nielsen J, Haeberli G.Hymenoptera venom allergy: analysis of double positivity to honey beeand Vespula venom by estimation of IgE antibodies to species-specificmajor aller¬gens Api m1 and Ves v5. Allergy 2008;64: 543-8. 22. Yunginger JW. Insect allergy (Adults and Children). In: Bierman CW,Pearlman DS (eds). Allergic diseases from infancy to adulthood. Phi-ladelphia: WB Saunders Co.; 1988. 678-83. 23. Reisman RE. Allergy to stinging insects. In: Paterson R, GrammerLC, Greenberger PA (eds). Allergic diseases. Philadelphia: Lippin-cott-Raven Publ.; 1997. 253-64. 24. Fischer TJ, Lawlor GJ Jr. Insect Allergy. In: Jr Lawlor GJ, FischerTJ, Adelman DC (eds). Manual of Allergy and Immunology (ThirdEdition). Boston: Little, Brown and Company; 1995. 253-61. 25. Graft DF, Valentine MD. Insect sting allergy. In: Kaplan AP (ed): Al-lergy. Philadelphia: WB Saunders Co.; 1997, 652-63.26. Golden DBK. Insect allergy. In: Adkinson NF, Yunginger JW, Bus-se WW, et al., editors. Mid-dleton’s allergy: principles and practi-ce. 6th ed. St. Louis: Mosby; 2003. p. 1475-86. 27. Mueller HL. Diagnosis and treatment of insect sensitivity. J AsthmaRes 1966;3 :331-333. 28.Bonifazi F, Jutel M, Biló BM, Birnbaum J, Muller U; EAACI InterestGroup on Insect Venom Hypersensitivity. Prevention and treatmentof hymenoptera venom allergy: guidelines for clinical practice. Al-lergy 2005;60(12):1459-70. 29- Sampson HA, Muñoz-Furlong A, Campbell RL, et al. Secondsymposium on the definition and management of anaphylaxis: sum-mary report, National Institute of Allergy and Infectious Disease/FoodAllergy and Anaphylaxis Network symposium. J Allergy Clin Immu-nol 2006;117(2):391-7. 30. Tracy JM. Insect allergy. Mt Sinai J Med. 2011;78(5):773-83. 31. Muller UR. Elevated baseline serum tryptase, mastocytosis andanaphylaxis. Clin Exp Allergy 2009;39:620-2. 32. Niedoszytko M, deMonchy J, vanDoormaal JJ, Jassem E, Oude-Elbe-rink JNG. Mastocytosis and insect venom allergy: diagnosis, safety andefficacy of venom immunotherapy. Allergy 2009;64:1237-45. 33. Bonadonna P, Perbellini O, Passalacqua G, et al. Clonal mast celldisorders in patients with systemic reactions to Hymenoptera stingsand increased serum tryptase levels. J Allergy Clin Immunol2009;123:680-6. 34. Simons FE, Ardusso LR, Bilò MB, et al. World Allergy Organiza-tion. World Allergy Organization anaphylaxis guidelines: summary.J Allergy Clin Immunol 2011;127(3):587-93. 35. Lieberman P, Nicklas RA, Oppenheimer J, et al. The diagnosis andmanagement of anaphylaxis practice parameter: 2010 update. J Al-lergy Clin Immunol. 2010;126(3):477-80. 36. Muraro A, Roberts G, Clark A, et al. EAACI Task Force on Anaphy-laxis in Children. The management of anaphylaxis in childhood: po-sition paper of the European academy of allergology and clinical im-munology. Allergy 2007;62(8):857-71. 37. Kemp SF, Lockey RF, Simons FE. World Allergy Organization adhoc Committee on Epinephrine in Anaphylaxis. Epinephrine: the drugof choice for anaphylaxis. A statement of the World Allergy Orga-nization. Allergy 2008;63(8):1061-70. 38. Joint Task Force on Practice Parameters; American Academy of Al-lergy, Asthma and Immunology; American College of Allergy,Asthma and Immunology; Joint Council of Allergy, Asthma and Im-munology. The diagnosis and management of anaphylaxis: An up-dated practice parameter. J Allergy Clin Immunol. 2005;115:483-523. 39. Doğru M, Duman H, Bostancı İ. Böcek ısırma ve sokmaları. TürkiyeKlinikleri Aile Hekimliği Özel Dergisi 2012;3(3):55-61. 40. Razi CH, Bakırtaş A. Arı Duyarlılığı (Hymanoptera alerjisi). KlinikPediatri, 2005;4(3):84-89. 41. Sin B. Böcek allerjisi. In: Aydilek R (ed). Allerjik hastalıklar ve bron-şial astma. Aktüel Tıp Dergisi 1998; I:179-204. 42. Allergen immunotherapy: a practice parameter. American Academyof Allergy, Asthma and Immunology. American College of Allergy, Asth-ma and Immunology. Joint Task Force on Practice Parameters. AnnAllergy Asthma Immunol 2003;90:1-40. 43. Perez-Riverol A, Justo-Jacomini DL, Zollner Rde L, Brochetto-Bra-ga MR. Facing Hymenoptera Venom Allergy: From Natural to Re-combinant Allergens. Toxins 20159;7:2551-70. 44. Luengo O, Cardona V. Component resolved diagnosis: when shouldit be used? Clin Transl Allergy. 2014;4:28. 45. Korosec P, Erzen R, Silar M, Bajrovic N, Kopac P, Kosnik M. Basop-hil responsiveness in patients with insect sting allergies and negati-ve venom-specific immu¬noglobulin E and skin prick test results. ClinExp Allergy 2009;39:1730-7. 46. Kucera P, Cvackova M, Hulikova K, Juzova O, Pachl J. Basophil ac-tivation can predict clinical sensitivity in patients after venom im-muno¬therapy. J Investig Allergol Immunol 2010;20:110-16. 47. Žitnik SE, Vesel T, Avčin T, Šilar M, Košnik M, Korošec P.Monitoringhoneybee venom immunotherapy in children with the basophil activa-tion test. Pediatr Allergy Immunol 2011;23:166-72. 48. Cox L, Nelson H, Lockey R, Calabria C, Chacko T, Finegold I, et al.Allergen immunotherapy: a practice parameter third update. J Al-lergy Clin Immunol 2011;127:1-55.