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Cross-reacting carbohydrate determinants and hymenoptera venom allergy

Brehler, Randolf; Grundmann, Sonja; Stöcker, Benedikt

Current Opinion in Allergy and Clinical Immunology: August 2013 - Volume 13 - Issue 4 - p 360–364
doi: 10.1097/ACI.0b013e328362c544
ANAPHYLAXIS AND INSECT ALLERGY: Edited by Theodore Freeman and Ralf Heine

Purpose of review Insect venom allergy is an important cause of anaphylaxis. Venom immunotherapy assume the clear identification of the culprit insect, but this is impeded by Immunoglobulin E (IgE) antibodies to cross reactive carbohydrate determinant (CCD) epitopes of common glycoproteins. Here we give an overview about inducers, importance, and relevance of anti-N-Glycan CCD IgE antibodies.

Recent findings Pollen exposure and insect stings induce anti-CCD IgE antibodies interfering with in-vitro tests for allergy diagnosis due to extensive IgE cross-reactivity. Instead of being biologically active these antibodies are irrelevant for allergic reactions due to hymenoptera stings. The general response of the immune system to the ubiquitous exposure to N-glycan containing glycoproteins is still a matter of debate. CCD specific IgG antibodies in sera of bee keepers suggest tolerance induction due to high-dose exposure. Tolerance induction by pollen and food glycoproteins has not been proved.

Summary Hymenoptera stings and pollen exposure induce anti-CCD IgE. In regard to anaphylaxis due to Hymenoptera stings these antibodies are not clinically relevant, but they are important for the specificity of in-vitro tests proving insect venom allergy. The introduction of component based diagnostic IgE testing improves the specificity of in-vitro tests if proteins devoid of CCD epitopes are used.

Department of Dermatology, University Hospital Muenster, Muenster, Germany

Correspondence to Randolf Brehler, University Hospital Muenster, Department of Dermatology, 48149 Muenster, Von-Esmarch-Street 58, Germany. Tel: +0049 251 835 6506; e-mail:

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