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PLoS One. 2018 Jun 25;13(6):e0199250. doi: 10.1371/journal.pone.0199250. eCollection 2018.

The culprit insect but not severity of allergic reactions to bee and wasp venom can be determined by molecular diagnosis.

Author information

Department of Pathophysiology and Allergy Research, Division of Immunopathology, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.
Department of Allergology and Clinical Immunology, 401 General Military Hospital, Athens, Greece.
University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia.
Department of Dermatology and Allergy, University of Bonn, Bonn, Germany.



Allergy to bee and wasp venom can lead to life-threatening systemic reactions. The identification of the culprit species is important for allergen-specific immunotherapy.


To determine a panel of recombinant bee and wasp allergens which is suitable for the identification of bee or wasp as culprit allergen sources and to search for molecular surrogates of clinical severity of sting reactions.


Sera from eighty-seven patients with a detailed documentation of their severity of sting reaction (Mueller grade) and who had been subjected to titrated skin testing with bee and wasp venom were analyzed for bee and wasp-specific IgE levels by ImmunoCAPTM. IgE-reactivity testing was performed using a comprehensive panel of recombinant bee and wasp venom allergens (rApi m 1, 2, 3, 4, 5 and 10; rVes v 1 and 5) by ISAC chip technology, ImmunoCAP and ELISA. IgG4 antibodies to rApi m 1 and rVes v 5 were determined by ELISA and IgE/IgG4 ratios were calculated. Results from skin testing, IgE serology and IgE/IgG4 ratios were compared with severity of sting reactions.


The panel of rApi m 1, rApi m 10, rVes v 1 and rVes v 5 allowed identification of the culprit venom in all but two of the 87 patients with good agreement to skin testing. Severities of sting reactions were not associated with results obtained by skin testing, venom-specific IgE levels or molecular diagnosis. Severe sting reactions were observed in patients showing < 1 ISU and < 2kUA/L of IgE to Api m 1 and/or Ves v 5.


We identified a minimal panel of recombinant bee and wasp allergens for molecular diagnosis which may permit identification of bee and/or wasp as culprit insect in venom-sensitized subjects. The severity of sting reactions was not associated with parameters obtained by molecular diagnosis.

Conflict of interest statement

Rudolf Valenta has received research grants from Biomay AG, Vienna, Austria, and Viravaxx, Vienna, Austria. He is a consultant for Biomay AG, and Viravax. Natalija Novak has received grants from the German Research Council, from GIF, CK Care and ALK Abello, served as a consultant for ALK Abello, HAL Allergy, Leti Pharma and Stallergenes and received lecture fees from ALK, HAL, Sanofi and Leti Pharma. The other authors have no conflict of interest to declare. Thermo Fisher Scientific provided the Api m 3 and Api m 5 ImmunoCAP tests. There are no patents, products in development or marketed products to declare. This does not alter our adherence to all the PLOS ONE policies on sharing data and materials, as detailed online in the guide for authors.

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