The preparations that are used for allergen immunotherapy against bee sting allergies do not always contain all the relevant venom components. This was the conclusion of an examination conducted by allergy experts at the Helmholtz Zentrum München and the Technical University of Munich (TUM). According to their report in ‘Human Vaccines and Immunotherapeutics’, this could possibly influence the treatment results.
This is where allergen-specific immunotherapy, commonly known as allergy shots, can help. The treatment involves injecting very small doses of the venom under the patient’s skin. The idea is to force the body to become accustomed to the poison and consequently to put an end to the immune system’s excessive reaction. According to Blank and his team, however, it may be necessary to improve the procedure.
Allergens strongly underrepresented
“We now know that bee venom is a cocktail of many different substances. In particular, there are five components that are especially relevant for allergy sufferers,” Blank explains. “In our current investigation of commercial preparations, however, we were able to show that these so-called major allergens are not present everywhere at sufficient levels, and some allergens are seriously underrepresented!”
While some preparations contained uniform levels of all venom components, in others up to three of the five allergens were present at levels that were too low, according to the authors. The scientists cannot concretely state exactly what this means for the therapeutic success. “So far, studies have not been able to prove how significant this is for the treatment. Because more than six percent of the patients are sensitized only against these three allergens, however, their underrepresentation could affect the treatment success, at least for these patients.“
Customized immunotherapy against bee stings?
Consequently, if patients react to specific allergens in bee venom but these are possibly not found in the preparations at sufficient levels, the question that must be asked is what good does immunotherapy against bee stings do for the individual.
ZAUM Director Prof. Dr. Carsten Schmidt-Weber sees it like this: “The vast majority of patients benefit from such a treatment. A desirable objective that results from this work, however, would be for patients to receive a customized treatment in the future. This would be a preparation with exactly the allergens to which the particular patient actually reacts.” Due to costs and the relatively small number of patients, however, such developments are still a long way off.
For their analysis, the researchers first produced antibodies against the five individual bee venom allergens in order to be able to detect these substances. Specifically, this involved proteins Api m 1, 2, 3, 5 and 10. The abbreviation Api m comes from the Latin term for the honey bee, Apis mellifera. Its venom is correspondingly called apitoxin. The researchers then tested the content of these components in four different preparations for allergen immunotherapy, while also examining different batches. Some preparations contained sufficient levels of all allergens, but some did not.
Specific studies are needed to provide findings regarding the effects on the treatment. Recently, however, a different study (Frick et al., JACI 2016) was able to show that sensitization principally with respect to Api m 10 constitutes an increased risk for the failure of the immunotherapy. The study did not examine if this is associated with a low content of Api m 10 in the preparations.
Blank, S. et al. (2017): Component-resolved evaluation of the content of major allergens in therapeutic extracts for specific immunotherapy of honeybee venom allergy. Human Vaccines and Immunotherapeutics, DOI: 10.1080/21645515.2017.1323603
The Helmholtz Zentrum München, the German Research Center for Environmental Health, pursues the goal of developing personalized medical approaches for the prevention and therapy of major common diseases such as diabetes and lung diseases. To achieve this, it investigates the interaction of genetics, environmental factors and lifestyle. The Helmholtz Zentrum München is headquartered in Neuherberg in the north of Munich and has about 2,300 staff members. It is a member of the Helmholtz Association, a community of 18 scientific-technical and medical-biological research centers with a total of about 37,000 staff members.
The Center of Allergy & Environment (ZAUM) in Munich is a joint undertaking by the Helmholtz Zentrum München and the Technical University of Munich (TUM). This cooperation, which is the only one of its kind in the German research landscape, is dedicated to interdisciplinary basic research and forms a link between clinicians at the hospital and clinical research staff at the university. Thanks to this approach, findings about the mechanisms that lie behind allergies are translated into preventive and therapeutic measures. The development of effective, individually tailored treatments enables better care to be provided for allergy-sufferers.
Technical University of Munich (TUM) is one of Europe’s leading research universities, with more than 500 professors, around 10,000 academic and non-academic staff, and 40,000 students. Its focus areas are the engineering sciences, natural sciences, life sciences and medicine, com-bined with economic and social sciences. TUM acts as an entrepreneurial university that promotes talents and creates value for society. In that it profits from having strong partners in science and industry. It is represented worldwide with a campus in Singapore as well as offices in Beijing, Brussels, Cairo, Mumbai, San Francisco, and São Paulo. Nobel Prize winners and inventors such as Rudolf Diesel, Carl von Linde, and Rudolf Mößbauer have done research at TUM. In 2006 and 2012 it won recognition as a German “Excellence University.” In international rankings, TUM regularly places among the best universities in Germany.
The Institute of Allergy Research (IAF) investigates the molecular mechanisms behind the development of allergies, which are on the rise around the world. Through intensive cooperation among scientists and clinicians on individual approaches to prevention, the IAF is working to halt this epidemiological spread. In the therapeutic area, the institute’s scientists want to develop new approaches specifically targeted at the patients. The IAF works with the Technische Universität München in the joint Center of Allergy & Environment (ZAUM) facility. The IAF is also a member of the Cluster Allergy and Immunity (CAI, www.cai-allergy.de) and the German Center for Lung Research (DZL).