Venom Immunotherapy in Hymenoptera Allergy

Hymenoptera venom immunotherapy (VIT) represents the only disease‐modifying treatment for individuals with life‐threatening allergic reactions to bee, wasp and related stings. By administering gradually increasing doses of venom extract, VIT induces peripheral immune tolerance characterised by reduced mast cell and basophil reactivity, a shift from IgE‐ to IgG4‐dominated antibody profiles and the expansion of regulatory T and B cell populations. Standardised build‐up and maintenance protocols achieve protection in over 90 per cent of patients, markedly reducing the risk of systemic reactions on subsequent stings. Ongoing research seeks to refine diagnostic precision, identify biomarkers predictive of treatment success or failure, and minimise adverse events, thereby extending the benefits of VIT to a broader global population.

Research from Nature Portfolio

Recent investigations have expanded the panel of key venom allergens used in component‐resolved diagnostics. A seminal study identified a 100 kDa dipeptidyl peptidase IV, designated Pol d 3, as a major allergen in Polistes dominula venom. Recombinant Pol d 3 demonstrated specific IgE reactivity in two‐thirds of sensitised patients and elicited basophil activation, underscoring its clinical relevance. Cross‐reactivity with homologous enzymes from honeybee and yellow jacket venom suggests shared IgE epitopes as well as unique sites suitable for differential diagnosis. This advance lays the groundwork for more accurate identification of culprit species and personalised immunotherapy formulations.

Venom Immunotherapy in Hymenoptera Allergy publication trend

The graph below shows the total number of articles in venom immunotherapy in hymenoptera allergy across all publications each year (not limited to Nature Index journals).

Technical terms

Venom Immunotherapy (VIT): A desensitisation protocol involving the administration of increasing doses of insect venom to induce immunological tolerance.
IgE‐mediated hypersensitivity: An immediate allergic response triggered when venom‐specific IgE antibodies cross‐link on mast cells and basophils upon sting exposure.
IgG4 blocking antibodies: A subclass of immunoglobulin G that competes with IgE for allergen binding and inhibits effector cell activation.
Basophil activation test (BAT): An in vitro assay that measures basophil responsiveness to allergen stimulation as an indicator of clinical sensitivity.
Regulatory T cells (Tregs): A subset of T lymphocytes that suppress immune responses and are essential for the induction and maintenance of peripheral tolerance.

References

1. Hymenoptera Venom Allergy: How Does Venom Immunotherapy Prevent Anaphylaxis From Bee and Wasp Stings?. Frontiers in Immunology (2019).
2. Clinical Effectiveness of Hymenoptera Venom Immunotherapy: A Prospective Observational Multicenter Study of the European Academy of Allergology and Clinical Immunology Interest Group on Insect Venom Hypersensitivity. PLOS ONE (2013).
3. Precision Medicine in Hymenoptera Venom Allergy: Diagnostics, Biomarkers, and Therapy of Different Endotypes and Phenotypes. Frontiers in Immunology (2020).
4. Cellular and Humoral Response After Induction of Protection and After Finishing Hymenoptera Venom Immunotherapy. Biomolecules (2024).
5. The high molecular weight dipeptidyl peptidase IV Pol d 3 is a major allergen of Polistes dominula venom. Scientific Reports (2018).