Multi-sensitization to hymenoptera venoms: diagnostic and clinical features

Background Double sensitization to both honeybee (Apis mellifera) and Yellow Jacket (Vespula ssp.) venom is common in up to 59% of Northern European Hymenoptera venom allergic patients and this rate is more than 50% in the United States. In Brazil yellow jacket is not a common wasp, but Polistes sp. and Polybia paulista poses the major risk for Brazilian patients. Reports about double sensitization involving honey bee and fire ant (Solenopsis invicta) are rare and there is nothing described about multi-sensitization to insects. Cross-reacting carbohydrate determinants (CCDs) are not present in Polistessp. venom and are not yet described for Polybia paulista neither Solenopsis invicta. Component-resolved analysis with recombinant species-specific major allergens may help to distinguish true double sensitization from crossreactivity, except for Polybia paulistaallergens for which these commercial tests are not yet available. Although there is no international consensus on whether immunotherapy regimens should generally include all venoms in multi-sensitized patients the recommendation is that immunotherapy (IT) should be extended to all venoms for which test results are positive and patients might potentially react to.