Predominant Api m 10 sensitization as risk factor for treatment failure in honey bee venom immunotherapy

Marcel Frick, Jörg Fischer, Arthur Helbling, Franziska Ruëff, Dorothea Wieczorek, Markus Ollert, Wolfgang Pfützner, Sabine Müller, Johannes Huss-Marp, Britta Dorn, Tilo Biedermann, Jonas Lidholm, Gerta Ruecker, Frank Bantleon, Michaela Miehe, Edzard Spillner, Thilo Jakob*

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

84 Citations (Scopus)


Background Component resolution recently identified distinct sensitization profiles in honey bee venom (HBV) allergy, some of which were dominated by specific IgE to Api m 3 and/or Api m 10, which have been reported to be underrepresented in therapeutic HBV preparations. Objective We performed a retrospective analysis of component-resolved sensitization profiles in HBV-allergic patients and association with treatment outcome. Methods HBV-allergic patients who had undergone controlled honey bee sting challenge after at least 6 months of HBV immunotherapy (n = 115) were included and classified as responder (n = 79) or treatment failure (n = 36) on the basis of absence or presence of systemic allergic reactions upon sting challenge. IgE reactivity to a panel of HBV allergens was analyzed in sera obtained before immunotherapy and before sting challenge. Results No differences were observed between responders and nonresponders regarding levels of IgE sensitization to Api m 1, Api m 2, Api m 3, and Api m 5. In contrast, Api m 10 specific IgE was moderately but significantly increased in nonresponders. Predominant Api m 10 sensitization (>50% of specific IgE to HBV) was the best discriminator (specificity, 95%; sensitivity, 25%) with an odds ratio of 8.444 (2.127-33.53; P = .0013) for treatment failure. Some but not all therapeutic HBV preparations displayed a lack of Api m 10, whereas Api m 1 and Api m 3 immunoreactivity was comparable to that of crude HBV. In line with this, significant Api m 10 sIgG4 induction was observed only in those patients who were treated with HBV in which Api m 10 was detectable. Conclusions Component-resolved sensitization profiles in HBV allergy suggest predominant IgE sensitization to Api m 10 as a risk factor for treatment failure in HBV immunotherapy.

Original languageEnglish
Pages (from-to)1663-1671.e9
JournalJournal of Allergy and Clinical Immunology
Issue number6
Publication statusPublished - 1 Dec 2016


  • Apis mellifera
  • HBV allergy
  • Hymenoptera venom allergy
  • allergen-specific immunotherapy
  • recombinant allergen
  • treatment failure


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