Improved recombinant Api m 1- and Ves v 5-based IgE testing to dissect bee and yellow jacket allergy and their correlation with the severity of the sting reaction.

Background No study has assessed the diagnostic sensitivity of rApi m1 and rVes v5 on Immulite testing system. Objective To compare the diagnostic sensitivity of commercially available venom recombinant allergens between the currently available immunoassays (ImmunoCAP [CAP] and Immulite [LITE]), and establish their correlation with the severity of the sting reaction.. Methods This study evaluated 95 bee venom and 110 yellow-jacket venom allergic subjects. We measured the levels of sIgE to rApi m1, rVes v5 (LITE and CAP), rApi m2 (LITE), rVes v1 (CAP) and tIgE (CAP). Forty-nine healthy subjects served as controls. Results The diagnostic sensitivity of rApi m1 and rVes v5 was significantly higher with the LITE than with the CAP system (71% vs. 88% and 82% vs. 93%). The specificity of both assays for both allergens was between 94% and 98%. Twenty-nine patients that tested negative for rApi m1 or rVes v5 with CAP were positive with LITE, but none of the patients that tested negative with LITE were positive with CAP. The positive values of rApi m1 and rVes v5 were on average 2.7 and 2.3 times higher, with the LITE than with the CAP system. The combination of rApi m1 and rApi m2 (LITE) and the combination of rVes v5 (LITE) and rVes v1 (CAP) almost matched the sensitivity of native venoms (95% and 97%, respectively), whereas the diagnostic sensitivity of the combination of rVes v5 and rVes v1 (CAP) did not reach the sensitivity of rVes v5 (LITE) alone (90% vs. 93%). IgE levels to venom recombinants and total IgE did not correlate with the severity of sting reaction. Conclusions & Clinical Relevance The use of rApi m1 and rVes v5 with the LITE system significantly enhanced diagnostic utility of venom recombinants and should improve the dissection of bee and yellow-jacket venom allergy. This article is protected by copyright. All rights reserved.