Wasp poison allergyT63.4

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.

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

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.

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.

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

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