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David B K Golden

Publications and source records attributed to David B K Golden.

11 recordsLinked to original sources
PubMed2006

Clinical and entomological factors influence the outcome of sting challenge studies.

BACKGROUND: The reported frequency of systemic reactions to challenge sting varies greatly. OBJECTIVE: To evaluate the interaction of clinical and entomological factors that determine the outcome of a challenge sting. METHODS: Patients allergic to yellow jacket were stung and monitored for systemic reaction. The frequency and severity of sting reactions were analyzed in relation to the species of insect used and patient characteristics. RESULTS: Objective systemic reactions occurred in 21 of 69 patients (30%) stung with Vespula maculifrons and in 8 of 71 patients (11%) with Vespula germanica (P=.005). Systemic reactions were more frequent in patients with a severe history (9/30; 30%) than in those with a mild or moderate history (21/145; 14%; P=.04). In only 1 of 111 patients (0.9%) was the reaction to sting challenge more severe than previous reactions. The reaction rate was higher when venom skin tests were positive at <1.0 microg/mL (17/75=23%) than when sensitivity was milder (9/100=9%; P=.012). We compared sting outcome and venom-induced histamine release in relation to insects collected in July or in October, and found no difference. CONCLUSION: Allergic reactions to sting challenge are determined by the species of yellow jacket used, the severity of previous sting reactions, and the degree of skin test sensitivity, but not by the time of year. These factors are important to clinicians when they evaluate the chance of reaction to a future sting and to researchers when they design and report sting challenge studies.

Adult↗
PubMed2006

Insect sting allergy and venom immunotherapy.

OBJECTIVE: To review specific aspects of venom immunotherapy (VIT) in the context of allergen immunotherapy (AIT) in general. DATA SOURCES: Immunotherapy Collegium II presented at the 2005 Annual Meeting of the American College of Allergy, Asthma and Immunology. STUDY SELECTION: Discussions of VIT during Immunotherapy Collegium II. RESULTS: The decision to recommend VIT is based on a detailed history and confirmatory diagnostic tests, as well as a knowledge of the natural history of the disease and its impact on quality of life. Skin tests and radioallergosorbent tests are complementary in that neither can detect all cases of insect sting allergy. Unlike inhalant AIT, rush regimens are as safe as slower regimens for initial VIT, and 4- to 8-week maintenance intervals are typical for VIT. In contrast to inhalant AIT, large local reactions are common and expected with VIT and should not limit the maintenance dose. VIT induces full immune tolerance in 85% of patients after 5 years, whereas this occurs in 30% to 50% of patients with inhalant AIT. VIT is often discontinued after 5 years even though skin test results are usually still positive, but a 10% to 15% chance of reaction persists for many years and is greater in patients who had near-fatal reactions before treatment, those who had systemic reactions during VIT, those with honeybee allergy, and those treated for less than 5 years. Children who receive 3 to 5 years of VIT have a lasting immune tolerance for 10 to 20 years afterward. CONCLUSION: The appropriate use of VIT for prevention of insect sting allergy requires knowledge of the natural history of the disease and would benefit from a better understanding of the mechanisms of successful immunotherapy for the induction of immune tolerance.

Bites and Stings↗
PubMed2006

Insect allergy in children.

PURPOSE OF REVIEW: Some aspects of insect sting allergy are unique in children. This review will identify and update the published data that exist pertaining specifically to insect allergy in children. RECENT FINDINGS: Children have a different pattern of insect sting allergy than adults. Honeybee allergy is more common in children. Severe systemic reactions are less common than in adults but the risk of recurrence can persist for decades. Systemic reactions are limited to mild 'cutaneous' reactions in over 60% of children (but only 15% of adults). Children with mild systemic reactions rarely get worse. Children with moderate or severe systemic reactions still had a 30% chance of a similar reaction even 20 years later. The long-term immune tolerance induced by venom immunotherapy is greater in children than adults. Children who had received venom immunotherapy for 3-5 years were still immune 10-20 years later. SUMMARY: Children with insect sting allergy are tested and treated in much the same way as adults. Children with mild systemic reactions do not require testing or immunotherapy. Children with moderate to severe systemic reactions are at risk for decades and should receive venom immunotherapy, which gives very long-lasting protection.

Anaphylaxis↗
PubMed2005

Insect sting allergy and venom immunotherapy: a model and a mystery.

Whole-body extracts of Hymenoptera were used for diagnosis and treatment until controlled clinical trials proved them no better than placebo, whereas venom is 85% to 98% effective. Studies of natural history reveal why whole-body extracts were thought to work. The chance of future systemic reactions is low in large local reactors and in most children and varies between 20% and 70% in adults. Venom skin tests are most accurate, but RAST is an important complementary test. The degree of sensitivity on skin tests or RASTs does not reliably predict the severity of a sting reaction. Venom immunotherapy is recommended for patients at high risk for sting reactions. Rapid regimens are as safe as slower regimens. The recommended dose is 100 microg, but some patients require higher doses for full protection. Venom immunotherapy is continued every 4 to 8 weeks for at least 5 years in most cases. Skin test results become negative in only 25% after 5 years of therapy but in 60% to 70% after 7 to 10 years. When treatment is stopped after 5 years or more, there is a 10% chance of systemic reaction to each future sting, but most reactions are mild. Some patients have a higher risk of relapse and should continue treatment for an extended period.

Adult↗
PubMed2005

Increased expression of osteopontin is associated with long-term bee venom immunotherapy.

BACKGROUND: Venom allergen immunotherapy (VIT) is proven to be highly effective for insect allergy, but the mechanisms and the biomarkers associated with clinical efficacy remain elusive. OBJECTIVE: The aim of this study was to identify candidate biomarkers associated with successful VIT. METHODS: Gene chip array and clustering analyses of PBMCs from subjects with or without VIT were performed. RESULTS: From gene chip array and clustering analyses, an increased expression of osteopontin was found in patients who completed 5 to 6 years of VIT and discontinued therapy for 3 to 6 years (completed treatment group) compared with the untreated group. A significantly higher level of serum osteopontin was found in the completed treatment group compared with the untreated group (n = 16 in each group; P < .001). CONCLUSION: The upregulation of osteopontin after VIT suggests a role of osteopontin as a candidate biomarker for VIT.

Adult↗
PubMed2004

Outcomes of allergy to insect stings in children, with and without venom immunotherapy.

BACKGROUND: Children are thought to "outgrow" the allergy to insect stings, but there are no reports documenting the natural history of this reaction. We studied the outcome of allergic reactions to insect stings in childhood 10 to 20 years afterward in patients who had not received venom immunotherapy and in those who had been treated. METHODS: Between 1978 and 1985, we diagnosed allergic reaction to insect stings in 1033 children, of whom 356 received venom immunotherapy. We conducted a survey of these patients by telephone and mail between January 1997 and January 2000, to determine the outcome of stings that occurred in the period from 1987 through 1999. RESULTS: Of the 1033 patients, 512 patients (50 percent) responded, with a mean follow-up period of 18 years, a mean duration of venom immunotherapy of 3.5 years in treated patients, and an incidence of stings of 43 percent. Systemic reactions occurred less frequently in patients who had received venom immunotherapy (2 of 64 patients, or 3 percent) than in untreated patients (19 of 111 patients, or 17 percent; P=0.007). Patients with a history of moderate-to-severe reactions had a higher rate of reaction if they had not been treated (7 of 22 patients, or 32 percent) than if they had received venom immunotherapy (2 of 43 patients, or 5 percent; P=0.007). In patients who had been treated and who had a history of mild (cutaneous) systemic reaction (i.e., one with only cutaneous manifestations), none of the 21 subjects who received stings had a systemic reaction. CONCLUSIONS: A clinically important number of children do not outgrow allergic reactions to insect stings. Venom immunotherapy in children leads to a significantly lower risk of systemic reaction to stings even 10 to 20 years after treatment is stopped, and this prolonged benefit is greater than the benefit seen in adults.

Animals↗
PubMed2004

Patterns of anaphylaxis: acute and late phase features of allergic reactions.

Anaphylaxis is usually defined as a multi-system allergic reaction, but includes isolated shock or airway obstruction. Hives do not occur in 20-30% of cases. Gastrointestinal (GI) symptoms are more common with foods. Cardiac anaphylaxis can cause arrhythmias, bradycardia or chest pain with ECG changes. Plasma histamine level correlates with hives and GI symptoms. Serum tryptase is elevated less often in food allergy, and correlates poorly with plasma histamine level. Anaphylaxis occurs in 30/100,000 population/year (mortality 1-2%) and is caused by foods (35%), drugs/ biologicals (25%), insect stings (15%), exercise (5%) or is idiopathic (20%). Onset of anaphylaxis to stings or allergen injections is usually rapid: 70% begin in < 20 minutes and 90% in < 40 minutes. Food/ingestant anaphylaxis may have slower onset or slow progression. Rapid onset is associated with greater severity. Prolonged anaphylaxis can be resistant to epinephrine and i.v. fluids. Biphasic allergic reactions which recur some hours after the early phase of the reaction were reported in 25% of cases of fatal and near-fatal food reactions, and in 23% of drug/biological reactions. But they occurred in only 6% of anaphylaxis of mixed causes and are uncommon with insect stings. Late phase (biphasic) reactions rarely occur without initial hypotension or airway obstruction.

Allergens↗
PubMed2003

Stinging insect allergy.

Systemic allergic reactions to insect stings are estimated to occur in about 1 percent of children and 3 percent of adults. In children, these reactions usually are limited to cutaneous signs, with urticaria and angioedema; adults more commonly have airway obstruction or hypotension. Epinephrine is the treatment of choice for acute anaphylaxis, and self-injection devices should be prescribed to patients at risk for this allergic reaction. Stinging insect allergy can be confirmed by measurement of venom-specific IgE antibodies using venom skin tests or a radioallergosorbent test. Patients with previous large local reactions have a 5 to 10 percent risk of experiencing systemic reactions to future stings. Patients with previous systemic reactions have a variable risk of future reactions: the risk is as low as 10 to 15 percent in those with the mildest reactions and in some children, but as high as 70 percent in adults with the most severe recent reactions. Because of demonstrated efficacy (98 percent), venom immunotherapy is recommended for use in patients who are at risk for severe systemic reactions to future insect stings. Venom immunotherapy is administered every four to eight weeks for at least five years. Immunotherapy may be needed indefinitely in patients at higher risk for recurrence of anaphylaxis after treatment is stopped.

Anaphylaxis↗
PubMed2003

Negative venom skin test results in patients with histories of systemic reaction to a sting.

For more than 20 years venom immunotherapy has been the preferred treatment for Hymenoptera allergy and venom skin testing the preferred diagnostic test. Most allergists consider venom skin tests to be highly accurate and interpret a negative venom skin test result to indicate the absence of insect allergy. Furthermore, current practice guidelines do not adequately address the question of how best to manage the patient with a convincing history of insect allergy but negative skin test results. Recent case reports and published studies have forced us to reexamine this important management issue and to consider what role in vitro venom testing might have in the management of insect allergy. We reviewed the current status of what is known about the management of individuals with a history of insect allergy but negative venom skin test results and suggested modifications of current working guidelines.

Anaphylaxis↗