Page 626 - Clinical Immunology_ Principles and Practice ( PDFDrive )

602 Part FIVE Allergic Diseases

Order +\PHQRSWHUD

Suborder $SRFULWD

Legion $FXOHDWD

Superfamily $SRLGHD 9HVSRLGHD 6FROLRLGHD

Family $SLGDH 9HVSLGDH 0\UPLFLQDH )RUPLFLGDH

Subfamily $SLQDH %RPELQDH 9HVSLQDH 3ROLVWLQDH 0\UPLFLQDH )RUPLFLQDH

Genus $SLV %RPEXV 9HVSXOD 'ROLFKRYHVSXOD 9HVSD 3ROLVWHV 0\UPHFLD 6ROHQRSVLV 3RJRQRP\UPH[ )RUPLFD

Species $SLV %RPEXV 9HVSXOD ' PHGLD 9 FUDEUR 3 GRPLQXOXV 0 SLORVXOD 6 LQYLFWD 3 UXJRVXV ) UXID
PHOOLIHUD WHUUHVWULV JHUPDQLFD ' VD[RQLFD 9 RULHQWDOLV 3 JDOOLFXV DQG RWKHUV DQG RWKHUV DQG RWKHUV DQG RWKHUV
DQG RWKHUV DQG RWKHUV YXOJDULV ' PDFXODWD 3 H[FODPDQV
PDFXOLIURQV ' DUHQDULD 3 IXVFDWXV
DQG RWKHUV ' V\OYHVWULV DQG RWKHUV
FIG 43.1 Taxonomy of Hymenoptera.

TABLE 43.1 Popular Names of the Most from S. invicta contains a 37-kDa allergen and a 24-kDa allergen,
Frequent Hymenoptera in Europe and in the with some sequence homology to phospholipase A1 and to antigen
3
United States 5 from vespid venom. In ant venom from M. pilosula, only
pilosulin 1 has been identified as a major allergen so far. The
Popular Name Popular Name in genes of many major venom allergens have been cloned, and
Latin Name in Europe the United States many of them have also been expressed as recombinant proteins
Apis mellifera Honeybee Honey bee comparable in allergenic activity and enzymatic function to their
6-9
Bombus Bumblebee Bumble bee natural counterparts (see Table 43.2). The amount of venom
Vespula ssp. Wasp Yellow jacket injected during a sting varies between and within species,
Dolichovespula maculata — Bald-faced hornet especially in vespids. Bees release 50–140 µg venom per sting
arenaria — Yellow hornet and vespids much less: between 2 and 17 µg. 2
media Median wasp —
Vespa crabro Hornet European hornet
Polistes spp. Field wasp Paper wasp CLINICAL PICTURE
Solenopsis invicta — Fire ant
CLINICaL rELEVaNCE

and P. senna arensis in the Middle East, which may also cause • Not every swelling after an insect sting is caused by allergy.
systemic allergic reactions. 3 • Hymenoptera venom allergy is generally caused by systemic IgE.
• Although Hymenoptera venom allergy is not as prevalent as respiratory
allergies, severe systemic reactions—even fatal—occur regularly
ALLERGENS IN HYMENOPTERA VENOMS worldwide.

All Hymenoptera venoms contain low-molecular-weight sub-
stances, such as biogenic amines, phospholipids, amino acids, Symptoms of venom hypersensitivity are most often caused by
and carbohydrates, as well as peptides, such as melittin, apamin, immunoglobulin E (IgE)-mediated immunological mechanisms,
and kinins, which contribute to the toxic effect but which—except but occasionally by non–IgE-mediated immunological mecha-
melittin—are probably irrelevant with regard to allergies. The nisms. Rarely, nonimmunological mechanisms of mediator release
allergens of the important stinging Hymenoptera are shown in play a role. The clinical presentation is classified into normal, large
Table 43.2. Most of them are glycoproteins of 10–50 kilodaltons local, systemic allergic, systemic toxic, and unusual reactions. 1,2
(kDa) and some, for example, dipeptidylpeptidases, are glyco-
5
proteins of up to 102 kDa. The major allergens in bee venom Normal Local Reactions
are phospholipase A2, hyaluronidase, and acid phosphatase; in The normal local reaction of a nonallergic subject to a Hyme-
vespid venoms, antigen 5 and phospholipase A1. Ant venom noptera sting consists of a painful, sometimes itchy, local wheal