Stellenwert des Histamin-Release-Tests aus Vollblut als Verlaufsparameter der Immuntherapie bei Kindern mit Insektengiftallergie

Beginning in 1988, we conducted a study at the Children's hospital of the Technical University of Munich to answer the following questions: Does the histamine release test on whole blood differ in children with insect venom allergy requiring immunotherapy compared to non-allergic controls? How do these responses change during immunotherapy? How does the histamine release develop after the end of immunotherapy? Methods: The in vitro histamine release test was performed in heparinized whole blood using the histamine RIA (Pharmacia) and the insect venom Reless (Scherax) also used for immunotherapy. Since 1992, we analyzed the histamine release after incubation with anti-IgE (Behring) in the dilution 1:1000 (400 IU/ml) to rule out the non-release phenomenon. Patients: Prior to immunotherapy the histamine release test was performed with blood from 31 wasp venom allergic, and 23 bee venom allergic children requiring immunotherapy, and a group of 99 children without insect sting allergy. 27 (13 wasp, 14 bee venom allergic) out of 54 allergic children undergoing immunotherapy lasting 3 years were prospectively studied. Specific IgE and IgG antibodies and the histamine release test were measured before immunotherapy and once per year during the therapy. Subsequently 14 patients were followed to a maximum of 3 years. Results: Prior to immunotherapy we found a significantly higher histamine release in allergic children than in non-allergic controls. This difference was no longer observed at the end of immunotherapy. Over a period of a maximum of 3 years after immunotherapy recurrence of an increased histamine release was found in 3 out of 14 patients. We conclude that the histamine release test is a useful parameter for monitoring immunotherapy in children with insect venom allergies. In case of non-responders, the injection interval or dose have to be reconsidered. The relevance of increased release results after immunotherapy has to be studied further.