History of insect venom allergy

Reports on abnormal reactions to insect stings date back into antiquity and have been more clearly described in the 19th century. Together with the development of scientific allergology they were clearly recognized as hypersensitivity reactions of an altered immunological reactivity. After the First World War attempts were started to treat with "desensitization" using whole body extracts of honey bees or wasps. This procedure was recommended by the insect allergy committee of the American Academy of Allergy on the basis of a large study published in 1965. However, there were doubts about its efficacy, especially when purified venom extracts were available prepared by electric stimulation of honey bees or by preparation of wasp venom sacs. At the end of the 1970s two randomized controlled prospective studies in USA and in Europe showed that whole body extract immunotherapy was as effective as placebo with a protection rate of about 25 - 35% while purified venom extracts gave protection rates of 75 - 95%. This was the breakthrough for a new type of allergenspecific immunotherapy which is now standard all over the world and has become a real success story for clinical allergy. Due to the availability of recombinant allergens the differences between hymenoptera species were differentiated more clearly. This has proven extremely helpful in the diagnosis of patients with "double" sensitizations against honey bee and wasp venoms. Molecular allergy diagnostics belong to the standard in vitro testing of insect sting allergic individuals. The future will show whether allergen-specific immunotherapy using recombinant allergens may be superior to classical purified whole insect venom extracts.