ALLERGY & IMMUNOLOGICAL TREATMENT WITH BEE VENOM
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Categorically defining allergy, it is a chronic disease that can lead to different symptoms. Its symptoms can vary from one person to another and according to the season. Allergy is a Greek word, which means a reaction that has been altered. Defining furthermore, an allergen triggers an unnatural response of our immune system to fight the external elements. According to research, it has been found that there are more than 30 different hormones that lead to allergic reactions. Most prominent are leukotrienes, prostaglandins, and histamine.
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Now, let's have a look at what allergy looks like. The common symptoms of allergy are skin swelling and redness, asthma, coughing, red eyes, nasal congestion, runny nose, and itching. Nearly 20% of the total population has some sort of allergic complaints and nearly 10% have asthma. Allergens – the allergic substances – responsible for triggering these symptoms are found everywhere around us. Like some food items, house molds, road contaminants, mites, pollen, aerosols, etc.
There are two categories of allergy: IgE-mediated allergy and non-IgE-mediated allergy. To treat allergy, most commonly, anti-histamines and steroids like cortisone are prescribed. To manage severe allergy, immunotherapy – in different doses – is also given to control the symptoms.
Therapeutic Effects of Bee Venom on Immunological and Neurological Diseases
Koreans have been using Bee Venom, since long, to treat inflammatory diseases and to relieve pain symptoms. Recent clinical studies, to a satisfactory extent, have proved that BV and its derivatives can be used in the treatment of Parkinson’s disease, autoimmune and neurodegenerative diseases and immunological diseases.
For its proper functioning, Bee Venom is facilitated by the immune cells present in the glial cells and periphery and the neurons of the central nervous system. Bee Venom emerged as a medical therapy in ancient China and Greece. There are numerous scientific reports present that prove the anti-inflammatory and anti-rheumatic effects of bee venom.
According to the clinical study, it was found that the SIT significantly increases the production of IL-10 by the APCs also including macrophages, monocytes, and B-cells. The efficiency of the SIT has been highlighted in respiratory allergies and insect venom allergy.
Venom immunotherapy encourages activation of monocytes that is further characterized by delayed overproduction of tumor necrosis factor-alpha and IL_12. Bee venom therapy also generated IL_10 and transformed growth factor-beta that strongly increased IgA and IgG4 and decreased IgE.
Thousands of successful BV therapy cases have been executed in Korea. And people have recovered from skin diseases, asthma, herniation nucleus pulpous, arthritis, rheumatism, and even cancer. All thanks to the active elements like histamine, apamin, melittin, phospholipase, etc.
466 Bee Venom Immunotherapy with Standardized Extract, Two Case Communication and Clinical Progress
BV immunotherapy is an effective and safe treatment for those patients, who have a history of strong systematic reactions to the Bee Venom. Talking about Mexico, there is no homogenous bee venom extract available for treating patients. Though, Mexico is known for its active beekeeping practice as it produces more than 70 tons of honey annually. In the same manner, according to the data gathered, there are nearly 17,500 bee sting cases reported each year.
According to research carried out on 2 patients, having a history of strong systematic reaction to occupational exposure and been venom, both with a demonstrated sensitization presented different reactions. They underwent a special process of immunotherapy during which Alk-US only 100mcg (the standard extract) was given to them weekly as per the norm of the maintenance cycle. The clinical course was conducted for four years.
From some generalized to local reaction the treatment was tolerated satisfactorily. It was concluded that immunotherapy, could be tolerated well and its effectiveness is also high in patients. In sensitized patients, it helps prevent the development of any life-threatening reactions.
Combination Of Omalizumab And Bee Venom Immunotherapy: Does It Work?
B-VIT (bee venom immunotherapy) can be mixed with omalizumab to control systematic reactions that originate due to bee venom immunotherapy itself. Here is a case of a patient, who was administered both therapies at the same time – b-VIT and omalizumab.
The patient also has a history of hypotension, dyspnea, angioedema and urticarial after getting stung by a honeybee. Skin prick test confirmed sensitization to the apis mellifera. Injection having 0.4mL of the fourth vial (100,000 SQ units/mL) was given to the patient and after five minutes he developed anaphylaxis.
After one week, IT was administered having the only 0.1mL of the fourth vial. A similar episode of anaphylaxis occurred again. A series of similar treatment was carried out by altering the dosage and timing, but the reaction remained the same.
Later omalizumab 150mg (for 15 days) was also combined with IT. It was found that omalizumbad plus IT didn’t lead to anaphylaxis. Later, omalizumab was also discontinued after 30 days once the maintenance phase was over.
In the second phase of maintenance dose; itching, dyspnea, cough and urticarial developed right after 15 minutes of administering omalizumbad plus IT injection. To control the symptoms diphenhydramine 45.5mg, adrenaline 0.5mg and methylprednisolone and IM 40mg were administered with short gaps.
Later, after 15 days, the patient was first given omalizumab 150mg and then IT with a gap of four hours. The dose of IT was decreased to 0.4mL of the fourth vial. After the half, an hour the patient developed symptoms similar to the last experiment.
It was concluded that a positive outcome of an IT injection is not necessary for those patients, who experience persistent systematic reactions. The same is the case with omalizumbad plus IT injection. Associated risks need to be explored after conducting several more treatments.
Omalizumab: A Useful Tool for Inducing Tolerance to Bee Venom Immunotherapy
Venom immunotherapy is an effective treatment for sting anaphylaxis that occurs in nearly 3% of adults. The reason being, VIT has an impressive success percentage of 98% while BVIT has also a satisfactory percentage of 85%. BVIT has a higher percentage of adverse and adverse systematic reactions that are reported to be at 14%.
Two patients, aged 12 years and 17 years experienced strong systematic reactions after a bee sting. Boy aged 12 years, developed angioedema followed with dyspnea and cough and systematic urticaria. While the second boy aged 17, years developed rash and lost consciousness. Both of them had a history of asthma and allergic rhinitis.
They were taking cetirizine 10mg and antileukotrience 10mg daily. To further carry out the treatment, both were administered BVIT using a standardized venom preparation following a proper schedule.
BVIT was stopped after a final dose of 25mcg; delivered in 4 different doses of 1mcg, 3mcg, 6mcg, and 15mcg, with a gap of thirty minutes. The reason was the occurrence of asthma, hypotension and facial angioedema. Emergency treatment was given immediately based on hydrocortisone 500mg and clorfeniramine 10mg. The spirometric respiratory parameter showed FEV1 levels dropping in both the patients. Later the patients recovered significantly after receiving adrenaline 0.5mL.
According to the results of the dosing schedule that was derived after matching body weight and the total dose of IgE, the first boy received omalizumab 525mg and the second boy received omalizumab 450mg every 15 days. The cases reported above show that omalizumab is certainly a perfect therapeutic option for preventing reactions related to BVIT immunotherapy.
Epitope-Specific T Cell Tolerance To Phospholipase A2 In Bee Venom Immunotherapy And Recovery By IL-2 And IL-15 In Vitro
The major allergen – bee venom phospholipase has a glycopeptide T-cell epitope and three peptides, which are experienced by both non-allergic and allergic sensitized subjects. For this clinical study, PLA epitope-specific T-cell and simple PLA and cytokine response in PBMC of the bee sting patients were examined before and after immunotherapy with WBV.
It was recorded that the proliferation of T-cell epitope peptide and PLA – specific T cell was suppressed significantly. In the same manner, peptide-induced emission of IL-4, IL-13, and IL-5 and IFN-gamma and IL-2 cytokines was abolished.
Whereas, the proliferation and production of tetanus toxoid induced cytokine remained unchanged. Culturing Ag with PBMC in the presence of IL-15 and IL-2 response of T cell could easily be restored concerning the specific secretion and proliferation of IFN-gamma, IL-2 and type one T cell.
On the other hand, IL-13, IL-5, and IL-4 remained suppressed. These findings show that the bee venom therapy creates a state of tolerance in T cells that are allergen-specific, but not in the specific B cells.
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
In this group clinical examination, 357 patients were assessed, who had vespid venom or bee venom allergy. The effectiveness of VIT was verified by patient self-reporting and sting challenge. Nearly 22 patients showed generalized symptoms after a field sting or the sting challenge. Nearly 10% of the patients who were suffering from Hymenoptera venom allergy showed an elevated tryptase concentration. Further narrowing the scope of the study, only those patients were analyzed who showed the potential of VIT.
Maintenance dose was kept at 100ug for patients, who had normal symptoms. While patients experiencing severe side effects were given 200ug during the maintenance phase. It was found that BTC and treatment frequency had no sort of association during the maintenance phase. Though, a rise in BTC still projects a few smaller negative effects on the success percentage of VIT.
Dose-Dependence of Protection from Systemic Reactions to Venom Immunotherapy by Omalizumab
Any sort of systematic reaction to venom therapy is quite rare. But still, there are chances of the occurrence of systematic reactions. The rate for systematic reactions is higher for the honeybee if compared with vespid VIT.
Patients, who have repeated systematic reactions to VIT make it difficult to determine the particular effective dose of bee venom. In such cases, a pretreatment regime with omalizumba is generally indicated.
There was a case of a woman, 47 years old who showed allergic symptoms to bee venom. She experienced severe reactions twice after receiving bee stings. Furthermore, the systematic reactions were also severe in the case of VIT.
Pretreatment with corticosteroids and antihistamines along with omalizumab 300mg helped in controlling the occurrence of systematic reactions.
Finally, a dose of 450mg of omalizumab and 200mcg of bee venom helped in protecting the subject from experiencing systematic reactions to VIT. The most challenging issue is determining the exact dose of omalizumab required by the patient following the severity of the reaction and its compatibility with VIT.
An adequate VIT plus omalizumab clinical study is required to develop an immunotherapy regime that will protect patients from any sort of life-threatening systematic reactions.
Component-Resolved Evaluation of the Content of Major Allergens in Therapeutic Extracts for Specific Immunotherapy...
To treat honeybee venom, allergy specific immunotherapy has been described as the best curative treatment. It helps in protecting against any further strong anaphylactic sting reactions. According to a recent analysis, done on a molecular level, it was found that HBV constitutes a complex allergen source that also contains relevant allergens. Allergen content of therapeutic extracts can differ due to the diverse natural source material and dissimilar strategies of downstream processing carried out by the manufacturers.
In this lab study, HBVs of different therapeutic grade were used for immunotherapy. Using the allergen-specific antibodies the role of major allergens like Api m 3, Api m 5, Api m 10 in therapeutic extracts was determined.
Polyclonal antibodies having specificity for major allergens Api m 2, Api m 3 and Api m 10 were created by immunizing rabbits with CCD (cross-reactive carbohydrate determinant) allergens. To detect Api m 5 a recombinant monoclonal of IgE antibody was used. All of the rabbits showed superb reactivity with recombinant allergens.
All of the antibodies also proved to be extremely specific for natural allergens in HBV. The level of sensitivity of detection was determined with the help of dilution serious of crude venom. As a result, nearly all of the antibodies demonstrated proper detection of respective target allergens.
The data gathered demonstrated a variation in the quality of the therapeutic HBV dose in the context of the content of different important allergens. Proper standardization of the therapeutic venom extract dose can be done after determining the actual allergenic potency. It is to be concluded that allergen-specific antibodies carry valuable information, which can help in resolving therapeutic extract issues on a molecular level.
There are two categories of allergy: IgE-mediated allergy and non-IgE-mediated allergy. To treat allergy, most commonly, anti-histamines and steroids like cortisone are prescribed. To manage severe allergy, immunotherapy – in different doses – is also given to control the symptoms.
Therapeutic Effects of Bee Venom on Immunological and Neurological Diseases
Koreans have been using Bee Venom, since long, to treat inflammatory diseases and to relieve pain symptoms. Recent clinical studies, to a satisfactory extent, have proved that BV and its derivatives can be used in the treatment of Parkinson’s disease, autoimmune and neurodegenerative diseases and immunological diseases.
For its proper functioning, Bee Venom is facilitated by the immune cells present in the glial cells and periphery and the neurons of the central nervous system. Bee Venom emerged as a medical therapy in ancient China and Greece. There are numerous scientific reports present that prove the anti-inflammatory and anti-rheumatic effects of bee venom.
According to the clinical study, it was found that the SIT significantly increases the production of IL-10 by the APCs also including macrophages, monocytes, and B-cells. The efficiency of the SIT has been highlighted in respiratory allergies and insect venom allergy.
Venom immunotherapy encourages activation of monocytes that is further characterized by delayed overproduction of tumor necrosis factor-alpha and IL_12. Bee venom therapy also generated IL_10 and transformed growth factor-beta that strongly increased IgA and IgG4 and decreased IgE.
Thousands of successful BV therapy cases have been executed in Korea. And people have recovered from skin diseases, asthma, herniation nucleus pulpous, arthritis, rheumatism, and even cancer. All thanks to the active elements like histamine, apamin, melittin, phospholipase, etc.
466 Bee Venom Immunotherapy with Standardized Extract, Two Case Communication and Clinical Progress
BV immunotherapy is an effective and safe treatment for those patients, who have a history of strong systematic reactions to the Bee Venom. Talking about Mexico, there is no homogenous bee venom extract available for treating patients. Though, Mexico is known for its active beekeeping practice as it produces more than 70 tons of honey annually. In the same manner, according to the data gathered, there are nearly 17,500 bee sting cases reported each year.
According to research carried out on 2 patients, having a history of strong systematic reaction to occupational exposure and been venom, both with a demonstrated sensitization presented different reactions. They underwent a special process of immunotherapy during which Alk-US only 100mcg (the standard extract) was given to them weekly as per the norm of the maintenance cycle. The clinical course was conducted for four years.
From some generalized to local reaction the treatment was tolerated satisfactorily. It was concluded that immunotherapy, could be tolerated well and its effectiveness is also high in patients. In sensitized patients, it helps prevent the development of any life-threatening reactions.
Combination Of Omalizumab And Bee Venom Immunotherapy: Does It Work?
B-VIT (bee venom immunotherapy) can be mixed with omalizumab to control systematic reactions that originate due to bee venom immunotherapy itself. Here is a case of a patient, who was administered both therapies at the same time – b-VIT and omalizumab.
The patient also has a history of hypotension, dyspnea, angioedema and urticarial after getting stung by a honeybee. Skin prick test confirmed sensitization to the apis mellifera. Injection having 0.4mL of the fourth vial (100,000 SQ units/mL) was given to the patient and after five minutes he developed anaphylaxis.
After one week, IT was administered having the only 0.1mL of the fourth vial. A similar episode of anaphylaxis occurred again. A series of similar treatment was carried out by altering the dosage and timing, but the reaction remained the same.
Later omalizumab 150mg (for 15 days) was also combined with IT. It was found that omalizumbad plus IT didn’t lead to anaphylaxis. Later, omalizumab was also discontinued after 30 days once the maintenance phase was over.
In the second phase of maintenance dose; itching, dyspnea, cough and urticarial developed right after 15 minutes of administering omalizumbad plus IT injection. To control the symptoms diphenhydramine 45.5mg, adrenaline 0.5mg and methylprednisolone and IM 40mg were administered with short gaps.
Later, after 15 days, the patient was first given omalizumab 150mg and then IT with a gap of four hours. The dose of IT was decreased to 0.4mL of the fourth vial. After the half, an hour the patient developed symptoms similar to the last experiment.
It was concluded that a positive outcome of an IT injection is not necessary for those patients, who experience persistent systematic reactions. The same is the case with omalizumbad plus IT injection. Associated risks need to be explored after conducting several more treatments.
Omalizumab: A Useful Tool for Inducing Tolerance to Bee Venom Immunotherapy
Venom immunotherapy is an effective treatment for sting anaphylaxis that occurs in nearly 3% of adults. The reason being, VIT has an impressive success percentage of 98% while BVIT has also a satisfactory percentage of 85%. BVIT has a higher percentage of adverse and adverse systematic reactions that are reported to be at 14%.
Two patients, aged 12 years and 17 years experienced strong systematic reactions after a bee sting. Boy aged 12 years, developed angioedema followed with dyspnea and cough and systematic urticaria. While the second boy aged 17, years developed rash and lost consciousness. Both of them had a history of asthma and allergic rhinitis.
They were taking cetirizine 10mg and antileukotrience 10mg daily. To further carry out the treatment, both were administered BVIT using a standardized venom preparation following a proper schedule.
BVIT was stopped after a final dose of 25mcg; delivered in 4 different doses of 1mcg, 3mcg, 6mcg, and 15mcg, with a gap of thirty minutes. The reason was the occurrence of asthma, hypotension and facial angioedema. Emergency treatment was given immediately based on hydrocortisone 500mg and clorfeniramine 10mg. The spirometric respiratory parameter showed FEV1 levels dropping in both the patients. Later the patients recovered significantly after receiving adrenaline 0.5mL.
According to the results of the dosing schedule that was derived after matching body weight and the total dose of IgE, the first boy received omalizumab 525mg and the second boy received omalizumab 450mg every 15 days. The cases reported above show that omalizumab is certainly a perfect therapeutic option for preventing reactions related to BVIT immunotherapy.
Epitope-Specific T Cell Tolerance To Phospholipase A2 In Bee Venom Immunotherapy And Recovery By IL-2 And IL-15 In Vitro
The major allergen – bee venom phospholipase has a glycopeptide T-cell epitope and three peptides, which are experienced by both non-allergic and allergic sensitized subjects. For this clinical study, PLA epitope-specific T-cell and simple PLA and cytokine response in PBMC of the bee sting patients were examined before and after immunotherapy with WBV.
It was recorded that the proliferation of T-cell epitope peptide and PLA – specific T cell was suppressed significantly. In the same manner, peptide-induced emission of IL-4, IL-13, and IL-5 and IFN-gamma and IL-2 cytokines was abolished.
Whereas, the proliferation and production of tetanus toxoid induced cytokine remained unchanged. Culturing Ag with PBMC in the presence of IL-15 and IL-2 response of T cell could easily be restored concerning the specific secretion and proliferation of IFN-gamma, IL-2 and type one T cell.
On the other hand, IL-13, IL-5, and IL-4 remained suppressed. These findings show that the bee venom therapy creates a state of tolerance in T cells that are allergen-specific, but not in the specific B cells.
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
In this group clinical examination, 357 patients were assessed, who had vespid venom or bee venom allergy. The effectiveness of VIT was verified by patient self-reporting and sting challenge. Nearly 22 patients showed generalized symptoms after a field sting or the sting challenge. Nearly 10% of the patients who were suffering from Hymenoptera venom allergy showed an elevated tryptase concentration. Further narrowing the scope of the study, only those patients were analyzed who showed the potential of VIT.
Maintenance dose was kept at 100ug for patients, who had normal symptoms. While patients experiencing severe side effects were given 200ug during the maintenance phase. It was found that BTC and treatment frequency had no sort of association during the maintenance phase. Though, a rise in BTC still projects a few smaller negative effects on the success percentage of VIT.
Dose-Dependence of Protection from Systemic Reactions to Venom Immunotherapy by Omalizumab
Any sort of systematic reaction to venom therapy is quite rare. But still, there are chances of the occurrence of systematic reactions. The rate for systematic reactions is higher for the honeybee if compared with vespid VIT.
Patients, who have repeated systematic reactions to VIT make it difficult to determine the particular effective dose of bee venom. In such cases, a pretreatment regime with omalizumba is generally indicated.
There was a case of a woman, 47 years old who showed allergic symptoms to bee venom. She experienced severe reactions twice after receiving bee stings. Furthermore, the systematic reactions were also severe in the case of VIT.
Pretreatment with corticosteroids and antihistamines along with omalizumab 300mg helped in controlling the occurrence of systematic reactions.
Finally, a dose of 450mg of omalizumab and 200mcg of bee venom helped in protecting the subject from experiencing systematic reactions to VIT. The most challenging issue is determining the exact dose of omalizumab required by the patient following the severity of the reaction and its compatibility with VIT.
An adequate VIT plus omalizumab clinical study is required to develop an immunotherapy regime that will protect patients from any sort of life-threatening systematic reactions.
Component-Resolved Evaluation of the Content of Major Allergens in Therapeutic Extracts for Specific Immunotherapy...
To treat honeybee venom, allergy specific immunotherapy has been described as the best curative treatment. It helps in protecting against any further strong anaphylactic sting reactions. According to a recent analysis, done on a molecular level, it was found that HBV constitutes a complex allergen source that also contains relevant allergens. Allergen content of therapeutic extracts can differ due to the diverse natural source material and dissimilar strategies of downstream processing carried out by the manufacturers.
In this lab study, HBVs of different therapeutic grade were used for immunotherapy. Using the allergen-specific antibodies the role of major allergens like Api m 3, Api m 5, Api m 10 in therapeutic extracts was determined.
Polyclonal antibodies having specificity for major allergens Api m 2, Api m 3 and Api m 10 were created by immunizing rabbits with CCD (cross-reactive carbohydrate determinant) allergens. To detect Api m 5 a recombinant monoclonal of IgE antibody was used. All of the rabbits showed superb reactivity with recombinant allergens.
All of the antibodies also proved to be extremely specific for natural allergens in HBV. The level of sensitivity of detection was determined with the help of dilution serious of crude venom. As a result, nearly all of the antibodies demonstrated proper detection of respective target allergens.
The data gathered demonstrated a variation in the quality of the therapeutic HBV dose in the context of the content of different important allergens. Proper standardization of the therapeutic venom extract dose can be done after determining the actual allergenic potency. It is to be concluded that allergen-specific antibodies carry valuable information, which can help in resolving therapeutic extract issues on a molecular level.
Sources:
Component-resolved evaluation of the content of major allergens in therapeutic extracts for specific immunotherapy...
Elevated and cross‐responsive CD1a‐reactive T cells in bee and wasp venom allergic individuals
In Vitro and In Vivo Anti-Allergic and Anti-Inflammatory Effects of eBV, a Newly Developed Derivative of Bee Venom...
Quality-of-life in insect venom allergy: validation of the Turkish version of the “Vespid Allergy Quality of Life Questionnaire”
9α,11β-PGF2, a Prostaglandin D2 Metabolite, as a Marker of Mast Cell Activation in Bee Venom-Allergic Patients
Six years of INSTAND e. V. sIgE proficiency testing: An evaluation of in vitro allergy diagnostics
Testing the "toxin hypothesis of allergy": Mast cells, IgE, and innate and acquired immune responses to venoms
Proceedings of the Canadian society of allergy and clinical immunology annual scientific meeting...
88 Clinical Features and Diagnostic Value of Specific IGE to Component Allergen in Bee Venom Allergy in Korea
Therapeutic Effects of Bee Venom on Immunological and Neurological Diseases
466 Bee venom Immunotherapy with Standardized Extract, Two Case Comunication and Clinical Progress
Combination of omalizumab and bee venom immunotherapy: does it work?
Omalizumab: A useful tool for inducing tolerance to bee venom immunotherapy
Epitope-specific T cell tolerance to phospholipase A2 in bee venom immunotherapy and recovery by IL-2 and IL-15 in vitro.
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
Dose-dependence of protection from systemic reactions to venom immunotherapy by omalizumab
Component-resolved evaluation of the content of major allergens in therapeutic extracts for specific immunotherapy...
Elevated and cross‐responsive CD1a‐reactive T cells in bee and wasp venom allergic individuals
In Vitro and In Vivo Anti-Allergic and Anti-Inflammatory Effects of eBV, a Newly Developed Derivative of Bee Venom...
Quality-of-life in insect venom allergy: validation of the Turkish version of the “Vespid Allergy Quality of Life Questionnaire”
9α,11β-PGF2, a Prostaglandin D2 Metabolite, as a Marker of Mast Cell Activation in Bee Venom-Allergic Patients
Six years of INSTAND e. V. sIgE proficiency testing: An evaluation of in vitro allergy diagnostics
Testing the "toxin hypothesis of allergy": Mast cells, IgE, and innate and acquired immune responses to venoms
Proceedings of the Canadian society of allergy and clinical immunology annual scientific meeting...
88 Clinical Features and Diagnostic Value of Specific IGE to Component Allergen in Bee Venom Allergy in Korea
Therapeutic Effects of Bee Venom on Immunological and Neurological Diseases
466 Bee venom Immunotherapy with Standardized Extract, Two Case Comunication and Clinical Progress
Combination of omalizumab and bee venom immunotherapy: does it work?
Omalizumab: A useful tool for inducing tolerance to bee venom immunotherapy
Epitope-specific T cell tolerance to phospholipase A2 in bee venom immunotherapy and recovery by IL-2 and IL-15 in vitro.
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
Dose-dependence of protection from systemic reactions to venom immunotherapy by omalizumab
