Wasp poison allergy T63.4

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 07.06.2022

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Synonym(s)

Allergy to wasps; Field Wasp Poison Allergy; German wasp; Hymenoptera allergy; Pole d 5; Vespula germanica; Ves v 1; Ves v 2; Ves v 3; Ves v 5; Ves v 6; Wasp; Wasp Allergy; Wasp poison allergy; Wasp sting allergy; Wasp venom

Definition
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Allergic reaction of the immediate type (type I allergy) to wasp venom. In Central Europe, systemic, anaphylactic wasp allergies are mainly caused by Vespula germanica and Vespula vulgaris.

For the field wasp (Polistes domenicus) the allergen Pol d 5 (field wasp component antigen 5 - major allergen, high cross-reactivity with Ves v 5 of other wasp species) plays a decisive role. Reactions to Dolichovespula spp. are rare, but possible in Central Europe.

Classification
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Known and identified allergens of Vespula vulgaris (Yellow jacket)

  • Ves v 1 Phospholipase A1: Species-specific major allergen, marker allergen for primary wasp venom sensitization.
  • Ves v 2 Hyaluronidase
  • Ves v 3 Vitellogenin (dipeptidyl peptidase): Minor allergen: dipeptidyl peptidase cross-reacting with the bee
  • Ves v 5 Antigen 5; major allergen, marker allergen for primary wasp venom sensitization
  • Ves v 6 Vitellogenin

Known and identified allergens of Polistes dominulus (field wasp, Mediterranean paper wasp)

  • Pol d 1 Phospholipase A1: allergenicity not known
  • Pol d 4 Serine protease::: Allergenicity not known
  • Pol d 5 Antigen 5: Major allergen, marker allergen for field wasp sensitization. High cross reactivity with Ves v 5 of Vespula vulgaris

Diagnosis
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With the available recombinant allergen components of bee venom (Api m1) or wasp venom (Ves v 5), the detection of a primary sensitization to bee or wasp venom or a true double sensitization is possible. This leads to a differentiated indication for specific immunotherapy (SIT = immunotherapy, specific).

For the field wasp (Polistes domenicus), which is important in the Mediterranean region, the allergen Pol d 5 (field wasp component antigen 5) plays a decisive role. For this detection, the recombinant (Pol d 5) field wasp component provides a marker that can be used to determine primary sensitization.

The venom components of Vespula spp. and Dolichovespula spp. show a sequence homology of 64-92%. However, with the available wasp venom preparations, no safe protection in Dolichovespula allergy seems to be achievable.

Therapy
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Prophylaxis
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Emergency set:

An emergency set is recommended for summer stays outside. It consists of 3 components:

  • H1 antihistamine (Fenistil® drops are recommended, 40-50 drops, half a tablespoon; alternatively, a small sip from the bottle if the dropper has been removed beforehand)
  • Glucocorticoid (a liquid preparation is recommended, e.g. Celestamine N 0.5 liq®. The entire content (30ml) of the bottle should be drunk. This corresponds to about 15 mg betamethasone.
  • Autoinjector with 300ug adrenaline autoinjector (e.g. Jext 300ug). The patient should have informed himself about the easy way of use before. The use should be practiced with a training pen if necessary.

Note(s)
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Identified single allergens of the different wasp and hornet species according to IUIS Allergen Nomenclature Sub-Committee (http://allergen.org )

  • Dolichovespula arenaria (Wasp species/Yellow hornet)
    • Dol a 5 Antigen 5
  • Dolichovespula maculata (Wasp species North America/White face hornet)
    • Dol m 1 Phospholipase A1B
    • Dol m 2 Hyaluronidase
    • Dol m 5 Antigen 5
  • Polistes annularis (paper wasp/wasp)
    • Pole a 1 Phospholipase A1B
    • Pole a 2 Hyaluronidase
    • Pole a 5 Antigen 5
  • Polistes dominula (Gallic field wasp/Mediterranean paper wasp)
    • Pole d 1 Phospholipase A1
    • Pole d 4 Serine protease
    • Pole d 5 Antigen 5
  • Polistes exclamans (paper wasp/wasp)
    • Pol e 1 Phospholipase A1
    • Pol e 4 Serine protease
    • Pole e 5 Antigen 5
  • Polistes fuscatus (field weeps/wasps)
    • Pole f 5 Antigen 5
  • Polistes gallicus (Gallic field wasp)
    • Pole g 1 Phospholipase A1
    • Pole g 5 Antigen 5
  • Polistes metricus (field weeps/wasps)
    • Pole m 5 Antigen 5
  • Polybia paulista (Wasp)
    • Poly p 1 Phospholipase A1
  • Polybia scutellaris (Wasp)
    • Poly s 5
  • Vespa crabro (European hornet)
    • Vesp c 1 Phospholipase A1B
    • Vesp c 5 Antigen 5
  • Vespa magnifica (Hornet/Hornet)
    • Vesp ma 2 Hyaluronidase 35 kDa No 2011-07-19 2011-07-22
    • Vesp ma 5 Antigen 5, member of PR-1 family
  • Vespa mandarinia (Hornet/Giant asian hornet)
    • Vesp m 1 Phospholipase A1B
    • Vesp m 5 Antigen 5
  • Vespula flavopilosa (Wasp/Yellow jacket)
    • Ves f 5 Antigen 5
  • Vespula germanica (German Wepse/Yellow jacket)
    • Ves g 5 Antigen 5
  • Vespula maculifrons (Wasp/Yellow jacket)
    • Ves m 1 Phospholipase A1B29
    • Ves m 2 Hyaluronidase
    • Ves m 5 Antigen 5
  • Vespula pensylvanica (Pennsylvanian wasp/Yellow jacket)
    • Ves p 5 Antigen 5
  • Vespula squamosa (Wasp/Yellow jacket)
    • Ves s 1 Phospholipase A1B
    • Ves s 5 Antigen 5
  • Vespula vidua (Wasp/Wasp)
    • Ves vi 5 Antigen 5
  • Vespula vulgaris (common wasp/yellow jacket)
    • Ves v 1 Phospholipase A1B
    • Ves v 2 Hyaluronidase
    • Ves v 3 Dipeptidylpeptidase IV
    • Ves v 5 Antigen 5
    • Ves v 6 Vitellogenin

Literature
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  1. Varga R.et al (2011) Does the current specific immunotherapy (SIT) with wasp venom offer protection against systemic reactions to stings of Dolichovespula spp. Abstract CD 46th DDG meeting P02/14
  2. Helbling A et al (2014) Update on Hymenopteran Poison Allergy with special aspects of diagnostics and therapy. Allergo J 22: 265-273

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

Authors

Last updated on: 07.06.2022