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Phylogenetic insights into the evolution of parasitism in hymenoptera.

The Hymenoptera are one of the four megadiverse orders of insects, with over 100000 described species and several times this number still waiting to be described. A major part of this diverse group is formed of large lineages of parasitoid wasps. Some of these lineages have in turn given rise to subgroups that have gone on to diversify into other lifestyles, such as gall-forming on, and pollination of, plants, as well as a broad array of food-collecting behaviors associated with social living in colonies. Thus, the Hymenoptera demonstrate the large evolutionary potential of parasitism as a lifestyle, in contrast to early assertions that parasitism tends to lead to evolutionary 'dead ends' driven by overspecialization. Phylogenetic approaches have already led to a number of important insights into the evolution of parasitism in Hymenoptera. A series of examples are discussed in this review, including the origin of parasitism in the order, the development of koinobiosis in some groups, coevolution with symbiotic viruses, and the evolution in some groups away from parasitism and into such habits as gall formation, pollination of figs, nest building and sociality. The potential for comparative analysis of hymenopteran habits is large, but progress is still in its early stages due to the paucity of available well-supported phylogenies, and the still limited accumulation of basic biological data for many taxa.

Animals↗

Efficacy of antihistamine pretreatment in the prevention of adverse reactions to Hymenoptera immunotherapy: a prospective, randomized, placebo-controlled trial.

BACKGROUND: Some clinical studies suggest that a combination of an H1- and H2-antagonist may be effective in the prophylaxis of allergic reactions. OBJECTIVE: The efficacy of pretreatment with an H1/H2-antagonist combination, H1-antagonist alone, or placebo in the prophylaxis of local and systemic adverse reactions to specific immunotherapy with Hymenoptera venom was compared. METHODS: In a prospective, randomized, double-blind, placebo-controlled study, 121 patients with Hymenoptera venom allergy were treated with rush immunotherapy and pretreatment with one of the following: 120 mg of terfenadine plus 300 mg of ranitidine, 120 mg of terfenadine alone, or placebo. The incidence of unwanted systemic adverse and local reactions was recorded for up to 50 weeks. RESULTS: In seven patients (6%), six in the placebo group and one in the terfenadine group, systemic side effects required cessation of therapy (p = 0.005). Subjective symptoms occurred in four patients (10%) in the terfenadine plus ranitidine group and in three patients (7%) in the terfenadine group. Regarding local reactions, significantly fewer patients treated with a combination of terfenadine and ranitidine and with terfenadine alone as compared with placebo had severe local symptoms of erythema (29%, 29%, and 49%), edema (24%, 18%, and 41%), and pruritus (13%, 11%, and 31%) at week 1 (p < 0.05). This therapeutic benefit was limited to the first 4 weeks of treatment. Treatment with a combination of terfenadine and ranitidine was not superior to treatment with terfenadine alone. CONCLUSIONS: Pretreatment with H1-antihistamines with or without H2-antihistamines significantly reduced local and systemic adverse reactions to immunotherapy with Hymenoptera venom and may therefore be helpful in the management of immunotherapy.

Administration, Oral↗

Specific ultrarush desensitization in Hymenoptera venom-allergic patients.

BACKGROUND: Hymenoptera venom hypersensitivity is an epidemiologically important problem. The only effective treatment in the management of venom-allergic patients with a history of generalized reactions to insect sting is specific immunotherapy. OBJECTIVE: To demonstrate safety and effectiveness of a modified ultrarush desensitization protocol in venom-allergic patients. METHODS: Fifty-seven patients with Hymenoptera venom allergy underwent a specific 1-day ultrarush desensitization by the subcutaneous route, reaching the cumulative dose of 101.1 microg in 2.5 hours. The maintenance dose (100 microg) was administered after 15 days and thereafter once a month. Patients were followed up for a year. Antihistamines were withheld for 15 days before and during desensitization to not underestimate the incidence of adverse effects. RESULTS: All patients but I completed the ultrarush desensitization. (This patient discontinued the treatment because of a hypertensive crisis not related to the desensitization.) The treatment caused a rapid variation of immunological parameters (IgE, IgG4) since the 15th day. After the desensitization, skin prick test results became negative in 15 patients (27%, decrease of 3.5 log), whereas they decreased in 14 patients (25%, decrease of 1 log). Sixty-four percent showed no adverse effects. Only 7% had a mild systemic reaction. CONCLUSIONS: Ultrarush desensitization is an effective and safe therapy in the management of patients with Hymenoptera venom allergy. In fact, it provides a faster tolerance, without significant differences regarding incidence of severe adverse effects, compared with traditional and rush protocols. It can be adopted for all patients, even children and teenagers.

Adolescent↗

Elevated basal serum tryptase and hymenoptera venom allergy: relation to severity of sting reactions and to safety and efficacy of venom immunotherapy.

BACKGROUND: Mastocytosis and/or elevated basal serum tryptase may be associated with severe anaphylaxis. OBJECTIVE: To analyse Hymenoptera venom-allergic patients with regard to basal tryptase in relation to the severity of sting reactions and the safety and efficacy of venom immunotherapy. METHODS: Basal serum tryptase was measured in 259 Hymenoptera venom-allergic patients (158 honey bee, 101 Vespula). In 161 of these (104 honey bee, 57 Vespula), a sting challenge was performed during venom immunotherapy. RESULTS: Nineteen of the 259 patients had an elevated basal serum tryptase. Evidence of cutaneous mastocytosis as documented by skin biopsy was present in 3 of 16 patients (18.8%). There was a clear correlation of basal serum tryptase to the grade of the initial allergic reaction (P<0.0005). Forty-one of the 161 sting challenged patients reacted to the challenge, 34 to a bee sting and 7 to a Vespula sting. Thereof, 10 had an elevated basal serum tryptase, i.e. 1 (2.9%) of the reacting and 2 (2.9%) of the non-reacting bee venom (BV) allergic individuals, as compared to 3 (42.9%) of the reacting and 4 (8%) of the non-reacting Vespula venom-allergic patients. Thus, there was a significant association between a reaction to the sting challenge and an elevated basal serum tryptase in Vespula (chi2=6.926, P<0.01), but not in BV-allergic patients. Systemic allergic side-effects to venom immunotherapy were observed in 13.9% of patients with normal and in 10% of those with elevated basal serum tryptase. CONCLUSIONS: An elevated basal serum tryptase as well as mastocytosis are risk factors for severe or even fatal shock reactions to Hymenoptera stings. Although the efficacy of venom immunotherapy in these patients is slightly reduced, most of them can be treated successfully. Based on currently available data, lifelong treatment has to be discussed in this situation.

Adolescent↗

Epidemiology of Hymenoptera allergy.

PURPOSE OF REVIEW: Epidemiology and especially the natural history of Hymenoptera allergy form the background that is essential to improving the clinical management of insect venom allergic patients. This review focuses on the emergence of recent data which could help provide further enlightenment in this field. RECENT FINDINGS: The latest data on the extent of the disease, the risk factors for sensitization and for local, systemic and fatal reactions after a hymenoptera sting are reviewed. The emerging problems concerning asymptomatic sensitization, the meaning of constitutively elevated tryptase serum levels and the persisting widespread poor awareness of available therapies in Hymenoptera allergic patients are particularly emphasized. SUMMARY: The assessment of the risk for systemic reaction in skin-positive subjects with a negative case history, and the suggestion of the baseline serum tryptase level as a risk factor for reaction severity after a sting, are the most important clinical implications of the latest studies. The genetic and environmental factors involved in the persistence of venom specific immunoglobulin E after a sting and the factors which orient towards a systemic or a large local reaction after apparently the same sting remain open questions.

Animals↗

Reproductive skew and split sex ratios in social Hymenoptera.

I present a model demonstrating that, in social Hymenoptera, split sex allocation can influence the evolution of reproductive partitioning (skew). In a facultatively polygynous population (with one to several queens per colony), workers vary in their relative relatedness to females (relatedness asymmetry). Split sex-ratio theory predicts that workers in monogynous (single-queen) colonies should concentrate on female production, as their relatedness asymmetry is relatively high, whereas workers in the polygynous colonies should concentrate on male production, as their relatedness asymmetry is relatively low. By contrast, queens in all colonies value males more highly per capita than they value females, because the worker-controlled population sex ratio is too female-biased from the queens' standpoint. Consider a polygynous colony in a facultatively polygynous population of perennial, social Hymenoptera with split sex ratios. A mutant queen achieving reproductive monopoly would gain from increasing her share of offspring but, because the workers would assess her colony as monogynous, would lose from the workers rearing a greater proportion of less-valuable females from the colony's brood. This sets an upper limit on skew. Therefore, in social Hymenoptera, skew evolution is potentially affected by queen-worker conflict over sex allocation.

Animals↗

The use of the radioallergosorbent test in the diagnosis of Hymenoptera anaphylaxis.

IgE antibody levels to Hymenoptera (honey bee, hornet, wasp or yellow jacket) venom or venom sac were measured in the serum of ninety-six patients with a history of immediate hypersensitivity reactions to these insect stings. Normal levels of IgE antibody were found in fourty-four of these patients tested. The severity of the systemic reaction was similar in those patients with normal and elevated IgE antibody levels, and the interval from the systemic reaction to antibody determination was also similar. In twelve patients with a definite reaction to honey bee venom, the IgE antibody was elevated in all and correlated with a positive venom skin test in nine out of the twelve. It is not possible to determine if the other patients with normal IgE antibody and a systemic reaction represent a false negative RAST value, loss of sensitivity to the Hymenoptera venom, or a lack of RAST sensitivity with some venom or venom sac antigens. Without the ready availability of venom skin tests to all Hymenoptera antigens or other in vitro tests, a definite assessment of insect anaphylaxis remains in doubt for the patient and physician.

Adolescent↗

Anaphylactic reactions to Hymenoptera stings in asthmatic patients.

We evaluated 587 cases with generalized reactions to stings of Hymenoptera. Eighty of these patients and twenty-eight normal controls had radioallergosorbent tests (RAST) to venoms of honey bee, yellow jacket, hornet, wasp and to phospholipase A. Those patients with systemic reactions had a significantly greater frequency of positive RAST than normal controls (51.3% vs. 7.1%, P < 0.001). The frequency of atopy (asthma/rhinitis) in case these 587 cases was only 22% and resembled the expected frequency in a general population. Asthmatic patients did not have an increased risk of developing systemic reactions to Hymenoptera stings. However, those asthmatic patients with systemic reactions to Hymenoptera stings had a significantly more severe anaphylactic reaction to a sting than non-asthmatics. These severe reactions were primarily manifested by acute dyspnoea, which appeared to represent a bronchospastic response to endogenous histamine release.

Anaphylaxis↗

A critical evaluation of RAST to venoms of Hymenoptera.

RAST to venoms were done on 108 sera. Positive RAST to one or more venoms of Hymenoptera found in 51% (41/80) patients with a generalized reaction to the sting of Hymenoptera and in 7% (2/28) of normal controls were critically evaluated. RAST determinations for each sera were done in duplicate and results averaged. The laboratories were not told which sera belonged to patients with allergy to Hymenoptera and which belonged to controls. In ten patients, one half of the original sera were saved and RAST to venoms were repeated approximately 1 1/2 years later. Of our positive RASTSs, 49% (20/41) had positives to more than one type of venom. The most frequent positive RAST was to yellow jacket followed by hornet, wasp, and honey bee. A high degree of cross-reactivity occured between venoms of hornet, wasp, and yellow jacket. The frequency of positive RAST was similar in pre-treatment and post-treatment sera from patients on immunotherapy with whole body extract. Specific IgE (RAST) results to venoms did not correlate with the degree of clinical severity of the sting. However, IgG anti-venom antibodies were not considered. Elevated RAST titres were associated with increased total IgE levels in sera of non-atopic patients. A positive RAST to venoms is frequently found in sera of patients stung within 5 years. RAST scores of 2 to 4 were remarkably reproducible, while scores of 1 were not consistently reproducible. RAST results should be interpreted in conjunction with the clinical history.

Humans↗

Association of features of atopy and diagnostic parameters in hymenoptera venom allergy.

In a total of 525 patients with hypersensitivity reactions to hymenoptera stings diagnostic parameters of hymenoptera venom (HV) allergy (severity of reactions, skin test threshold and RAST for bee and vespid venoms) were investigated for their relationship to the following indicators of atopy: positive history of atopic diseases, elevated (less than or equal to 100 kU/l) total serum IgE and positive prick test reactions to common inhalant allergens (CIA) (grass pollen, cat epithelium, house dust mite). There was a conclusive history of atopic disease in 25%, a total serum IgE greater than or equal to 100 kU/l in 48%, and at least one positive reaction to CIA in 53%. Total IgE greater than or equal to 100 kU/l correlated with a higher frequency of RAST classes greater than or equal to 2 (P less than 0.01) and with less severe reactions to hymenoptera stings (P less than 0.05). In the presence of at least one positive reaction to CIA, there were more frequently skin test thresholds less than or equal to 10 micrograms/ml (P less than 0.05) and RAST classes greater than or equal to 2 (P less than 0.01) for HV than in CIA prick test negative individuals. There was no significant, relationship between the other pairs of parameters evaluated. Thus, reactivity to HV in diagnostic tests is increased in the presence of certain indicators of atopy. This has to be considered in the interpretation of skin test and RAST results obtained with HV.

Adolescent↗

The CD63 basophil activation test in Hymenoptera venom allergy: a prospective study.

BACKGROUND: The basophil activation test (BAT), which relies on flow cytometric quantitation of the allergen-induced up-regulation of the granule-associated marker CD63 in peripheral blood basophils, has been suggested to be a useful approach in detecting responsiveness to allergens. The purpose of this study was to establish the usefulness of the BAT with regard to the clinical history and current diagnostic tools in Hymenoptera venom allergy using a prospective study design. METHODS: Fifty-seven consecutive patients allergic to Hymenoptera venom as defined by a systemic reaction after an insect sting, and 30 age- and sex-matched control subjects with a negative history were included. The degree and nature of sensitization was confirmed by skin testing, specific immunoglobulin E (IgE), serum tryptase levels and BAT. In the nonallergic control group only analysis of specific IgE and BAT were performed. Correlation of BAT, skin test and specific IgE, respectively, with the clinical history in the allergic group was termed as sensitivity and in the control group as specificity. RESULTS: Twenty one of 23 (91.3%) bee venom allergic patients and 29 of 34 (85.3%) patients allergic to wasp and hornet venom tested positive in BAT. The overall sensitivity of BAT, specific IgE and skin tests were 87.7, 91.2 and 93.0%, respectively. The overall specificities were 86.7% for BAT and 66.7% for specific IgE. No correlation between the severity of clinical symptoms and the magnitude of basophil activation was observed. CONCLUSION: The BAT seems to be an appropriate method to identify patients allergic to bee or wasp venom with a comparable sensitivity to standard diagnostic regimens. The higher specificity of BAT as compared with specific IgE makes this test a useful tool in the diagnosis of Hymenoptera venom allergy.

Animals↗

Histamine, tryptase, norepinephrine, angiotensinogen, angiotensin-converting enzyme, angiotensin I and II in plasma of patients with hymenoptera venom anaphylaxis.

Markers of immediate-type hypersensitivity such as histamine and tryptase were measured in the plasma of nonallergic volunteers and patients with a history of hymenoptera venom anaphylaxis. No significant differences in histamine or tryptase were found between patients and controls. Norepinephrine, an important compound involved in the control of cardiovascular functions and blood pressure, was the same in patients and nonallergic volunteers. In addition, components of the renin-angiotensin system were determined. Patients with hymenoptera venom anaphylaxis showed significantly lower plasma angiotensinogen concentrations as compared to healthy nonallergic controls (p < 0.007), whereas plasma ACE activity was the same. Likewise, the plasma levels of angiotensin I and angiotensin II were significantly reduced in patients as compared to controls (p < 0.04 and p < 0.003, respectively). These findings suggest that the renin-angiotensin system may play an important role as a counteracting factor in hymenoptera venom anaphylaxis.

Adult↗

Atopy and systemic reactions to hymenoptera stings.

To evaluate whether atopy is a risk factor for systemic reactions to hymenoptera stings, we compared the atopic status of two groups of subjects. The first group included 93 patients (59 males), mean (+/- SD) age: 42.3 +/- 17.2 yrs with a history of anaphylactic reactions to hymenoptera stings. The second was a control group of 712 subjects (379 males), mean (+/- SD) age: 42.0 +/- 9.6 years recruited at a public health care center. The protocol included a standardized questionnaire about symptoms suggestive of atopy, i.e. medical diagnosis of asthma, perennial rhinitis or hay fever, and skin tests to common aeroallergens, i.e. house dust mites, cat danders, and grass pollens. The percentage of subjects with atopic symptoms was comparable in the two groups (32.2% for the patient group and 28.5% for the control group). Similarly, 22.6% of patients and 36.8% of controls exhibited at least one positive skin prick test. Lastly, 15.1% of patients and 18.5% of controls (a nonsignificant difference) had at least one symptom of atopy and at least one positive skin test. These findings show that atopy is not a risk factor for systemic reactions to hymenoptera stings.

Adult↗

[Desensitization of allergy to hymenoptera venoms].

Hyposensitization (immunotherapy) of hymenoptera venom allergy has been practised for 70 years. About 20 years ago the use of ineffective whole-body extracts was abandoned, as effective therapy with preparations of bee venom and wasp venom became available. The diagnosis of hymenoptera venom allergy is based on history, skin tests and determination of venom specific IgE-antibodies in the serum. Only rarely other tests are needed (histamine or leukotriene release tests, immunoblot, specific IgG antibodies). To achieve a definite diagnosis, all findings have to be considered carefully, as "false positive" and "false negative" results can occur in all test systems. Hyposensitization is indicated in all patients with systemic IgE-mediated immediate type reactions, only in children with exclusive skin symptoms it may not be needed. Contraindications of hyposensitization are to be considered. Allergen preparations for subcutaneous injection are available as aqueous preparations or as aluminium hydroxide-adsorbed depot extracts. Various rush or conventional treatment protocols are used to reach the maintenance dose of usually 100 micrograms venom/four weeks. The most frequent side effects are large local reactions, which are observed in almost all patients. Systemic anaphylactic side effects also occur in up to 40%, in most cases the symptoms are mild. To identify patients who are not protected by the usual maintenance dose, a sting challenge test with a living insect should be performed. By this, about 80 to 100% of the patients are found to be protected from systemic symptoms, and in those still reacting an increased dose of 200 micrograms (or even higher) eventually induces protection. Hyposensitization may be stopped if it lasted at least for 3 to 5 years, if systemic side-effects did not occur and if the patient has tolerated a sting challenge or a field-sting without systemic symptoms. In patients intensely exposed to hymenoptera or in those with an increased risk of severe reactions, longer treatment has to be considered.

Anaphylaxis↗

Case report of an aviator with a single episode of altered consciousness due to Hymenoptera hypersensitivity.

This case is presented to: a) emphasize the importance of a careful history, including interviewing witnesses and considering a complete differential diagnosis when evaluating aviators with a history of an episode of altered consciousness; and b) demonstrate an appropriate use of literature review, subspecialty consultations, and U.S. Air Force Aeromedical Guidelines to arrive at an aeromedical disposition for an unusual case. A military aviator experienced an episode of syncope/near syncope, initially felt to be caused by a primary seizure or an arrhythmia. Subsequent thorough evaluation included careful history taking, extensive interviewing of witnesses, subspecialty consultations, review of appropriate literature and deliberation by a board of experienced military aeromedical physicians. Cardiac and neurologic diagnoses were considered but careful history and witness interviews revealed that the aviator had sustained an insect sting just minutes before the episode. Evaluation by allergy specialists, including skin testing, identified him as being hypersensitive to Hymenoptera stings. A diagnosis of hypersensitivity reaction to a Hymenoptera sting was determined to be the cause of the altered consciousness episode. Review of the literature revealed that immunotherapy for Hymenoptera sensitivity reduces the risk of future anaphylaxis to only 1-2% after maintenance dose is achieved. Consideration of the risk of future events and the success of rush immunotherapy resulted in a recommendation for a waiver to return the aviator to unrestricted flying duties. The importance of diligent history taking must never be forgotten. In this aviator it led to the correct diagnosis and definitive therapy. In addition, appropriate consideration of the literature and knowledge of outcome rates allowed a return to unrestricted flying for this aviator. If the original diagnosis of seizure or arrhythmia had been accepted, this aviator would have been disqualified without waiver and a valuable flying asset would have been lost.

Adult↗

[Mastocytosis: an important differential diagnosis in anaphylactoid reaction to Hymenoptera sting. A case report and overview of clinical aspects, diagnosis and current therapy of mastocytosis].

A 77-year old farmer presented with a history of three severe anaphylactoid reactions after hymenoptera stings for the last three years. No sensitisation to hymenoptera venoms could be shown on allergological work-up. The serum level of tryptase however was clearly elevated (37.1 micrograms/l; normal value: < 13.5 micrograms/l). The diagnosis of systemic mastocytosis could be confirmed by bone marrow biopsy. Patients with mastocytosis are at increased risk of anaphylactic/anaphylactoid reactions. They should be educated how to avoid trigger factors and they should always carry an emergency kit (H1 blocker, corticosteroid, adrenalin) and a "mastocytosis pass" with them. Venom immunotherapy is indicated in patients with proven hymenoptera allergy. Selected patients at very high risk of anaphylactic reactions may need a continuous prophylactic medication with H1 and H2 blocker and eventually a cyclooxygenase inhibitor.

Aged↗

[Clinical and biological surveillance after the cessation of Hymenoptera venom desensitization].

107 patients have discontinued Hymenoptera venom immunotherapy between 1988 and 2000. 31 have been seen again with intradermal tests with IgEs, and 81 responded to a questionnaire. Intradermal reactions and IgEs decrease together significantly during immunotherapy and then persist at low level during three years. Beyond, the number of patients is insufficient. 32 patients were stung by the same Hymenoptera and not had any systemic reaction. However, five have beta blockers, three have IEC and half of the patients don't take precautions to avoid Hymenoptera.

Adolescent↗

Prevalence of allergic reactions to Hymenoptera stings in northern Italy.

The epidemiology of Hymenoptera venom allergy in Europe showed prevalence of systemic reactions of about 3%, but is scantly investigated in Italy. We studied two samples of the general and an at risk population, i.e. the foresters, in northern Italy. A standardized questionnaire dealing with allergic reactions to Hymenoptera stings was submitted to the subjects included in the study, who were factory workers in Milan and Verona and foresters in Lombardy. An overall number of 574 subjects participated to the study, 462 (299 males and 163 females, mean age 40.1 yrs, range 20-63 yrs) were factory workers and 112 (all males, mean age 38.8 yrs, range 24-59 yrs) were foresters. Among factory workers, 302 (65.4%) were stung by Hymenoptera, 49 (10.6%) had had large local reactions, and 13 (2.8%) systemic reactions. Among foresters, 76 (67.8%) were stung, 11 (9.8%) had had large local reactions, and 5 (4.5%) systemic reactions. The systemic reactions were life-threatening in 3 (0.6%) industrial workers and 2 (1.8%) foresters. The prevalence of systemic reaction of 2.8% in the general population agrees with the data reported from a number of countries with temperate climate. The prevalence of 4.5% in foresters attributed to this population a risk only slightly increased.

Adult↗