The analysis of Hymenoptera hypersensitive patients in Ankara, Turkey

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C: human recombinant IL-15 lane. Basal IL-15 was only detected in one CD patient. Gliadin induced IL-15 production in both non-CD controls (three out of three) and treated CD patients (seven out of eight). Ascorbate inhibited IL-15 production in all cases, even in a patient who had detectable basal levels of IL-15." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D. Bernardo, B. Martínez-Abad, S. Vallejo-Diez, E. Montalvillo, V. Benito, B. Anta, L. Fernández-Salazar, A. Blanco-Quirós, J.A. Garrote, E. Arranz" "autores" => array:10 [ 0 => array:2 [ "nombre" => "D." "apellidos" => "Bernardo" ] 1 => array:2 [ "nombre" => "B." "apellidos" => "Martínez-Abad" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Vallejo-Diez" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "Montalvillo" ] 4 => array:2 [ "nombre" => "V." "apellidos" => "Benito" ] 5 => array:2 [ "nombre" => "B." "apellidos" => "Anta" ] 6 => array:2 [ "nombre" => "L." "apellidos" => "Fernández-Salazar" ] 7 => array:2 [ "nombre" => "A." "apellidos" => "Blanco-Quirós" ] 8 => array:2 [ "nombre" => "J.A." "apellidos" => "Garrote" ] 9 => array:2 [ "nombre" => "E." "apellidos" => "Arranz" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0301054611000851?idApp=UINPBA00004N" "url" => "/03010546/0000004000000001/v1_201304101101/S0301054611000851/v1_201304101101/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "The analysis of Hymenoptera hypersensitive patients in Ankara, Turkey" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "9" "paginaFinal" => "13" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Gul Karakaya, Ebru Celebioglu, A. Ugur Demir, A. Fuat Kalyoncu" "autores" => array:4 [ 0 => array:3 [ "nombre" => "Gul" "apellidos" => "Karakaya" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "Ebru" "apellidos" => "Celebioglu" "email" => array:1 [ 0 => "edamadoglu@yahoo.co.uk" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "¿" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "A. Ugur" "apellidos" => "Demir" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "A. Fuat" "apellidos" => "Kalyoncu" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Chest Diseases, Adult Allergy Unit, Hacettepe University Medical School, Ankara, Turkey" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Chest Diseases, Hacettepe University Medical School, Ankara, Turkey" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "textoCompleto" => "IntroductionHymenoptera venom can lead to systemic allergic reactions in up to 5% of the population in Europe and North America.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> In Turkey, the lifetime incidence of sting exposure and the incidence of systemic and severe systemic reaction rates were estimated to be 94.5%, 7.5%, and 2.2%, respectively.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> In children aged 6- 13 years, the lifetime cumulative sting prevalence and severe systemic reaction incidence were estimated to be 60.8% and 0.2%, respectively.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> It has been noted that Hymenoptera stings were most often caused by the honeybee, Apis Mellifera, and the vespid, Vespula Vulgaris, in Turkey.<a class="elsevierStyleCrossRef" href="#bib0020">4</a>To identify species of the offending insect, recommend treatment, and educate patients about avoidance measures, patients should undergo a diagnostic evaluation.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> A detailed and careful history can usually establish the diagnosis of Hymenoptera sting reaction.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> However, sensitisation should be confirmed by a skin test reaction to venom or the detection of venom-specific IgE-antibodies to identify the responsible species, because there may be recall bias.<a class="elsevierStyleCrossRef" href="#bib0030">6</a> The sensitivity and specificity of the utilised diagnostic tests are important for the correct diagnosis. Although there are some published data about the prevalence of honeybee (apis) and vespid (vespula) venom allergy, there has been no report about Hymenoptera venom immunotherapy practice from our country. Our aim was to determine the characteristics of Hymenoptera venom hypersensitivity and venom immunotherapy practice in Ankara, Turkey.Materials and methodsData of 65 Hymenoptera venom allergic patients who were followed up in our department from February 2005 to August 2009 were analysed. Immunotherapy was recommended to the patients with a history of immediate systemic reaction after a sting and demonstrable specific IgE either by skin testing or serum assay. The severity of reactions was graded according to the system proposed by HL Mueller.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> All patients with Hymenoptera hypersensitivity were recommended self-injectable adrenalin.To distinguish between honeybee and vespula, patients were asked several questions. Questions were about the patient's activity and location at the time of the sting and if he/she could recognise the insect. The presence of a stinger, which is left primarily by honeybees, is asked. Hymenoptera figures were used for visual identification of the insect, in case of doubt.Skin tests were performed with Apis and Vespula venom (Apis Mellifera, Vespula, Stallergenes, France) at least four weeks after the sting reaction.<a class="elsevierStyleCrossRefs" href="#bib0005">1,6</a> Skin prick test (SPT) was carried out with 1μg/ml of venom concentration, and if negative, then intradermal injections with concentration of tenfold dilutions ranging from 0.001- 1μg/ml and 0.02ml of venom were performed on the volar surface of the forearm.<a class="elsevierStyleCrossRef" href="#bib0030">6</a> The SPT was considered positive if a geometric mean diameter of the resulting wheal was at least 3mm after 15min.<a class="elsevierStyleCrossRef" href="#bib0040">8</a> Intradermal test was read as positive at a mean wheal diameter of at least 5mm with erythema with concentration of 1μg/ml or less.<a class="elsevierStyleCrossRef" href="#bib0045">9</a> Histamine and saline were used as positive and negative controls, respectively. The test was terminated at the positive concentration.Serum allergen specific IgE levels to Apis and Vespula venom were measured with the immunoCAP system (PhadiaAB, Upsala, Sweeden) according to the manufacturer's instructions. Specific IgE measurement was also performed at least two weeks after the sting reaction. The measuring range of the immunoCAP system is 0.35-100 kU/L. The results were graded as class 0, 1, 2, 3, 4, 5, and 6 with specific IgE levels of <0.35, 0.35-0.7, 0.7-3.5, 3.5-17.5, 17.5-50, 50-100, and >100kU/L, respectively. Results >0.35kU/L were considered as positive.Ultrarush desensitisation was performed to patients who live far from Ankara. Cumulative dose of 101.1μg/ml in 2.5hours was administered on the first day in an inpatient setting. The maintenance dose of 100μg/ml was administered after 15 days and thereafter once a month for a year.<a class="elsevierStyleCrossRef" href="#bib0050">10</a> Injection interval was six weeks for the second year and eight weeks for the third year until the end of five years.<a class="elsevierStyleCrossRef" href="#bib0055">11</a> All patients who received immunotherapy had also been prescribed self-injectable adrenalin. Pulse rate, blood pressure and peak expiratory flow rate were recorded during the desensitisation and after each injection during the maintenance phase. Full emergency resuscitation equipment was available. Injections were performed subcutaneously by experienced medical doctors. After each injection, patients were kept under medical observation for at least 30minutes. Conventional immunotherapy protocol was administered to remaining patients, who live in Ankara, with weekly injections for 16 weeks when the maintenance dose of 100μg/ml is reached. Maintenance injection intervals were the same as ultrarush protocol.Statistical analysisDescriptive data for categorical and numerical variables were expressed as frequencies and median with range in parenthesis, respectively. Results of specific IgE and intradermal testing were compared between the groups who reported Apis and Vespula sting, respectively. Mann-Whitney U test was used for the statistical testing. P values less than 0.05 was considered as statistically significant. The study protocol was accepted by the local ethical committee.ResultsA total of 65 patients were included in the analysis. Mean age of the study population was 40 (16-68, SD: 12.4) and 50.8% were females. Mean reaction age of the patients was 32.8±13.35 (5-57). According to patients’ history, Vespula was responsible for 52.3%, Apis for 27.7%, both Apis and Vespula for 9.2% of the reactions. Responsible Hymenoptera type was not known in 10.8% of the cases. According to Mueller's classification, incidence of Grade 1, 2, 3, 4 reactions were 4.6%, 18.5%, 29.2%, and 47.7%, respectively. Clinical data of patients receiving immunotherapy are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. Forty-six (70%) patients received immunotherapy, 17 (26%) self injectable adrenalin, and two (3%) did not receive any treatment (lost to follow-up). Clinical data of patients who did not receive immunotherapy are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Thirty-five patients (53.8%) had accompanying atopic disease, 14 of whom had rhinitis, nine had asthma and rhinitis, seven rhinitis, three aspirin-exacerbated respiratory disease and two drug hypersensitivity.Twelve patients are on the first, 14 on the second, four on the third, eight on the fourth, and five patients are on the fifth year of immunotherapy. Two patients are lost to follow up and one patient left treatment due to financial problems. Twelve patients were restung during immunotherapy and among them only two had systemic reactions, one grade 2, and the other one grade 3. These two patients self injected adrenalin.Serum Vespula specific IgE class (p:0.02) and Apis specific IgE class were high (p<0.0001) and Apis intradermal test results were positive (p<0.001) in accordance with the patients’ history. However, intradermal test results with Vespula were not consistent with self-reported Hymenoptera type (p:0.15). Eight out of 25 patients revealed negative skin test result with Vespula, five of whom had positive serum specific IgE, whereas intradermal test with Apis revealed only one negative result out of 15 Apis hypersensitive patients. In patients who underwent immunotherapy, both intradermal tests and serum specific IgE for Apis and Vespula were significantly correlated with immunotherapy bee type (p: 0.04, p<0.0001 and p<0.0001, p<0.0001, respectively). Vespula venom allergic patients tended to have high values of specific IgE against Apis. While Apis specific IgE and intradermal test results were correlated (rho: 0.59, p<0.0001), Vespula specific IgE and intradermal test results were not (rho: 0.2, p:0.17). Intradermal test against Vespula did not discriminate between Apis and Vespula hypersensitive patients. These results suggest that intradermal test for Vespula have limited diagnostic sensitivity. The association between test results and bee type are shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Nineteen patients did not receive immunotherapy, seven of whom were recommended and 12 of whom were not. Twelve patients were not recommended immunotherapy because tests were negative in six, concomitant severe disease was present in four, reaction was a mild urticaria in one, and no reaction in the second sting in one patient. In those 12 patients, self-reported Hymenoptera was vespula in nine, was not known in one and both apis and vespula in two patients. Among 19 patients who did not receive immunotherapy, 17 received self-injectable adrenalin only, 13 of whom had been stung with Vespula, two patients who were recommended immunotherapy with Apis were lost to follow up. The high number of patients in the only self-injectable adrenalin group who had been stung with Vespula also indicates that the diagnostic tests, especially the skin tests with Vespula may have limited diagnostic sensitivity.There were no significant differences when grade of reaction and specific IgE and intradermal test results were compared between Apis and Vespula. Serum specific IgE and intradermal test results of Grade 4 reaction were not different from Grade 1-2-3 reactions.DiscussionHoneybees usually do not sting without provocation; they mostly sting in defence of their nest and their queen, whereas yellow jackets tend to sting with minimal provocation. They are highly aggressive and will sting for no apparent reason, particularly in the autumn, when larger populations compete for limited food supplies.<a class="elsevierStyleCrossRefs" href="#bib0060">12,13</a> Among our Hymenoptera hypersensitive patients, based on self-reported Hymenoptera type, Vespula was responsible for 52.3% of the reactions, and Apis for 27.7%. Previous studies also reported higher incidence of Vespula hypersensitivity.<a class="elsevierStyleCrossRefs" href="#bib0070">14,15</a>For SPT, venom concentrations in the range of 1.0μg/mL are usually performed before intracutaneous tests, but are not used by all allergists.<a class="elsevierStyleCrossRefs" href="#bib0025">5,6</a> Even at 100μg/ml the sensitivity of SPT is lower than that of intradermal test.<a class="elsevierStyleCrossRef" href="#bib0080">16</a> We performed SPT with 1μg/ml venom concentration and only one patient with honeybee allergy was SPT positive. Although our study population is small and we performed SPT with 1μg/ml venom concentration, we can assume that prick testing rarely seems to be positive.The most striking finding in our study population was the low sensitivity of intradermal test with Vespula. Because of the irritative effect of commercially available venom preparations, concentrations higher than 1μg/ml cannot be used. Low level of specific IgE, however, can lead to systemic reactions, and may not be detected with intradermal testing with 1μg/ml concentration of the Vespula venom preparation.<a class="elsevierStyleCrossRef" href="#bib0085">17</a> Based on our results and previous reports, we recommend that negative skin test responses especially with Vespula, need further investigation.We previously reported that a history of seasonal and perennial rhinitis, food allergy, and physician-diagnosed asthma in Turkish beekeepers were associated with systemic sting reactions. The risk of systemic reaction increases approximately threefold when one atopic disease is present and eleven fold when two or more concurrent atopic diseases are present compared to having no atopic disease.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> In this study, 53.8% of our patients had concurrent atopic disease in accordance with our previous finding in beekeepers. Müller also reported that atopy may increase the risk and severity of systemic reactions in beekeepers and their family members.<a class="elsevierStyleCrossRef" href="#bib0095">19</a> However, Birnbaum et al. reported that the percentage of atopic subjects defined by clinical symptoms and positive skin tests to common aeroallergens was not higher among patients with a history of anaphylactic reaction to Hymenoptera sting than in controls with no such history. They suggested that atopy is not a risk factor for the occurrence of an anaphylactic reaction to Hymenoptera sting, at least among non-beekeepers.<a class="elsevierStyleCrossRef" href="#bib0100">20</a> We think that this issue should be further investigated.We analysed our Hymenoptera venom hypersensitive patients and we found some interesting data. However, there are some limitations of our analysis. First, our study population is small. Second, we performed the analysis based on self-reported Hymenoptera type and a considerable number of patients (10.8%) could not remember the responsible Hymenoptera and data of these patients are not included to the analysis. Also, there may have been recall bias. Nevertheless, we showed that if self-reported Hymenoptera is Apis, then the patient's report is very likely to be true.In conclusion, our aim was to determine the characteristics of Hymenoptera venom hypersensitivity and venom immunotherapy practice in Ankara, Turkey. We analysed the data of our patients and found that Vespula venom hypersensitivity was more common among our bee stung patients. Intradermal tests with Vespula have limited diagnostic sensitivity and are not correlated with serum specific IgE. In the case of negative skin test results, especially with Vespula, it should be kept in mind that it is not possible to fully exclude a future sting reaction.Conflict of interestThe authors have no conflict of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "xres86062" "titulo" => array:5 [ 0 => "Abstract" 1 => "Background" 2 => "Methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec74225" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Statistical analysis" ] ] ] 4 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 5 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 6 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interest" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2010-08-20" "fechaAceptado" => "2010-11-02" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec74225" "palabras" => array:7 [ 0 => "Hymenoptera" 1 => "Apis Mellifera" 2 => "Vespula Vulgaris" 3 => "Venom immunotherapy" 4 => "Intradermal test" 5 => "Venom hypersensitivity" 6 => "Bee allergy" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "BackgroundAlthough there are some published data about the prevalence of honeybee and vespid venom allergy from Turkey, there has been no report about Hymenoptera venom immunotherapy practice. Our aim was to determine the characteristics of Hymenoptera venom hypersensitivity and venom immunotherapy practice in Ankara, Turkey. MethodsDemographic and clinical data, intradermal test, and serum specific IgE results of 65 Hymenoptera venom allergic patients who were followed up in our department from February 2005 to August 2009 were analysed. ResultsSerum Vespula specific IgE class (p:0.02) and Apis specific IgE class were high (p<0.0001) and Apis intradermal test results were positive (p<0.001) in accordance with the patients’ history. However, intradermal test results with Vespula were not consistent with self-reported Hymenoptera type (p:0.15). While Apis specific IgE and intradermal test results were correlated with each other (rho: 0.59, p<0.0001), Vespula specific IgE and intradermal test results were not (rho: 0.2, p:0.17). Intradermal test against Vespula did not discriminate between Apis and Vespula hypersensitive patients. There were no significant differences when the grade of reaction and specific IgE and intradermal test results were compared between Apis and Vespula. ConclusionsVespula venom hypersensitivity was more common among our patients. However, intradermal tests with Vespula had limited diagnostic sensitivity and were not correlated with serum specific IgE. Based on our results and previous reports, we recommend that negative skin test responses, especially with Vespula, need further investigation." ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "Descriptive data for categorical and numerical variables were expressed as frequencies and median with range in parenthesis, respectively." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Vespula \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Apis \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Median Age (Range) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37.5 (17-56) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43 (20-59) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gender</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grade of reaction<a class="elsevierStyleCrossRef" href="#tblfn0010">‡</a></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prick test positivity (1μg/ml) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intradermal test positivity</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.001μg/ml \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">μg/ml \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">μg/ml \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">μg/ml \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not performed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SpIgE class</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not performed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Protocol</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ultra-rush \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Conventional \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Adverse reaction<a class="elsevierStyleCrossRef" href="#tblfn0015">†</a></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Large local \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Systemic grade 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">grade 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">grade 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab165354.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "*" "nota" => "Data of seven patients who received immunotherapy with both venoms are not included." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "‡" "nota" => "There were no grade 1 and large local reactions in the immunotherapy group." ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "†" "nota" => "No patients had grade 4 systemic reaction after injections." ] ] ] "descripcion" => array:1 [ "en" => "Clinical data of patients receiving immunotherapy<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a>" ] ] 1 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Apis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Vespula \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Responsible bee \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Reaction grade</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2-3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Skin prick test \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intradermal test</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.001μg/ml \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.01μg/ml \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.1μg/ml \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1μg/ml \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not performed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SpIgE class</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Immunotherapy recommended \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab165353.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "*" "nota" => "Data of two patients that the bee type is not known and two patients that Apis and Vespula were indicated are not included." ] ] ] "descripcion" => array:1 [ "en" => "Clinical data of patients who did not receive immunotherapy<a class="elsevierStyleCrossRef" href="#tblfn0020">*</a>" ] ] 2 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Vespula \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Apis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vespula class</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">n: 33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">n: 18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.025</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (1-3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (1.25-2.75) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Apis class</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">n: 32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">n:18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.0001</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (0-2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (2-3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intradermal Vespula<a class="elsevierStyleCrossRef" href="#tblfn0030">*</a></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">n: 25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">n: 12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.15</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (0-2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0-1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intradermal Apis<a class="elsevierStyleCrossRef" href="#tblfn0030">*</a></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">n: 13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">n:15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.0001</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0-0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (1.25-3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab165355.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "†" "nota" => "The analysis is 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Gul Karakayaa, Ebru Celebioglua,

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edamadoglu@yahoo.co.uk

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, A. Ugur Demirb, A. Fuat Kalyoncua

a Department of Chest Diseases, Adult Allergy Unit, Hacettepe University Medical School, Ankara, Turkey

b Department of Chest Diseases, Hacettepe University Medical School, Ankara, Turkey

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Hymenoptera venom can lead to systemic allergic reactions in up to 5&#37; of the population in Europe and North America&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In Turkey&#44; the lifetime incidence of sting exposure and the incidence of systemic and severe systemic reaction rates were estimated to be 94&#46;5&#37;&#44; 7&#46;5&#37;&#44; and 2&#46;2&#37;&#44; respectively&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In children aged 6- 13 years&#44; the lifetime cumulative sting prevalence and severe systemic reaction incidence were estimated to be 60&#46;8&#37; and 0&#46;2&#37;&#44; respectively&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> It has been noted that Hymenoptera stings were most often caused by the honeybee&#44; <span class="elsevierStyleItalic">Apis Mellifera</span>&#44; and the vespid&#44; <span class="elsevierStyleItalic">Vespula Vulgaris</span>&#44; in Turkey&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">To identify species of the offending insect&#44; recommend treatment&#44; and educate patients about avoidance measures&#44; patients should undergo a diagnostic evaluation&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> A detailed and careful history can usually establish the diagnosis of Hymenoptera sting reaction&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> However&#44; sensitisation should be confirmed by a skin test reaction to venom or the detection of venom-specific IgE-antibodies to identify the responsible species&#44; because there may be recall bias&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The sensitivity and specificity of the utilised diagnostic tests are important for the correct diagnosis&#46; Although there are some published data about the prevalence of honeybee &#40;apis&#41; and vespid &#40;vespula&#41; venom allergy&#44; there has been no report about Hymenoptera venom immunotherapy practice from our country&#46; Our aim was to determine the characteristics of Hymenoptera venom hypersensitivity and venom immunotherapy practice in Ankara&#44; Turkey&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Materials and methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">Data of 65 Hymenoptera venom allergic patients who were followed up in our department from February 2005 to August 2009 were analysed&#46; Immunotherapy was recommended to the patients with a history of immediate systemic reaction after a sting and demonstrable specific IgE either by skin testing or serum assay&#46; The severity of reactions was graded according to the system proposed by HL Mueller&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> All patients with Hymenoptera hypersensitivity were recommended self-injectable adrenalin&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">To distinguish between honeybee and vespula&#44; patients were asked several questions&#46; Questions were about the patient&#39;s activity and location at the time of the sting and if he&#47;she could recognise the insect&#46; The presence of a stinger&#44; which is left primarily by honeybees&#44; is asked&#46; Hymenoptera figures were used for visual identification of the insect&#44; in case of doubt&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Skin tests were performed with Apis and Vespula venom &#40;<span class="elsevierStyleItalic">Apis Mellifera</span>&#44; <span class="elsevierStyleItalic">Vespula</span>&#44; Stallergenes&#44; France&#41; at least four weeks after the sting reaction&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;6</span></a> Skin prick test &#40;SPT&#41; was carried out with 1<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;ml of venom concentration&#44; and if negative&#44; then intradermal injections with concentration of tenfold dilutions ranging from 0&#46;001- 1<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;ml and 0&#46;02<span class="elsevierStyleHsp" style=""></span>ml of venom were performed on the volar surface of the forearm&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The SPT was considered positive if a geometric mean diameter of the resulting wheal was at least 3<span class="elsevierStyleHsp" style=""></span>mm after 15<span class="elsevierStyleHsp" style=""></span>min&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Intradermal test was read as positive at a mean wheal diameter of at least 5<span class="elsevierStyleHsp" style=""></span>mm with erythema with concentration of 1<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;ml or less&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Histamine and saline were used as positive and negative controls&#44; respectively&#46; The test was terminated at the positive concentration&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Serum allergen specific IgE levels to Apis and Vespula venom were measured with the immunoCAP system &#40;PhadiaAB&#44; Upsala&#44; Sweeden&#41; according to the manufacturer&#39;s instructions&#46; Specific IgE measurement was also performed at least two weeks after the sting reaction&#46; The measuring range of the immunoCAP system is 0&#46;35-100 kU&#47;L&#46; The results were graded as class 0&#44; 1&#44; 2&#44; 3&#44; 4&#44; 5&#44; and 6 with specific IgE levels of &#60;0&#46;35&#44; 0&#46;35-0&#46;7&#44; 0&#46;7-3&#46;5&#44; 3&#46;5-17&#46;5&#44; 17&#46;5-50&#44; 50-100&#44; and &#62;100<span class="elsevierStyleHsp" style=""></span>kU&#47;L&#44; respectively&#46; Results &#62;0&#46;35<span class="elsevierStyleHsp" style=""></span>kU&#47;L were considered as positive&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Ultrarush desensitisation was performed to patients who live far from Ankara&#46; Cumulative dose of 101&#46;1<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;ml in 2&#46;5<span class="elsevierStyleHsp" style=""></span>hours was administered on the first day in an inpatient setting&#46; The maintenance dose of 100<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;ml was administered after 15 days and thereafter once a month for a year&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Injection interval was six weeks for the second year and eight weeks for the third year until the end of five years&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> All patients who received immunotherapy had also been prescribed self-injectable adrenalin&#46; Pulse rate&#44; blood pressure and peak expiratory flow rate were recorded during the desensitisation and after each injection during the maintenance phase&#46; Full emergency resuscitation equipment was available&#46; Injections were performed subcutaneously by experienced medical doctors&#46; After each injection&#44; patients were kept under medical observation for at least 30<span class="elsevierStyleHsp" style=""></span>minutes&#46; Conventional immunotherapy protocol was administered to remaining patients&#44; who live in Ankara&#44; with weekly injections for 16 weeks when the maintenance dose of 100<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;ml is reached&#46; Maintenance injection intervals were the same as ultrarush protocol&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Statistical analysis</span><p id="par0040" class="elsevierStylePara elsevierViewall">Descriptive data for categorical and numerical variables were expressed as frequencies and median with range in parenthesis&#44; respectively&#46; Results of specific IgE and intradermal testing were compared between the groups who reported Apis and Vespula sting&#44; respectively&#46; Mann-Whitney U test was used for the statistical testing&#46; P values less than 0&#46;05 was considered as statistically significant&#46; The study protocol was accepted by the local ethical committee&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">A total of 65 patients were included in the analysis&#46; Mean age of the study population was 40 &#40;16-68&#44; SD&#58; 12&#46;4&#41; and 50&#46;8&#37; were females&#46; Mean reaction age of the patients was 32&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;35 &#40;5-57&#41;&#46; According to patients&#8217; history&#44; Vespula was responsible for 52&#46;3&#37;&#44; Apis for 27&#46;7&#37;&#44; both Apis and Vespula for 9&#46;2&#37; of the reactions&#46; Responsible Hymenoptera type was not known in 10&#46;8&#37; of the cases&#46; According to Mueller&#39;s classification&#44; incidence of Grade 1&#44; 2&#44; 3&#44; 4 reactions were 4&#46;6&#37;&#44; 18&#46;5&#37;&#44; 29&#46;2&#37;&#44; and 47&#46;7&#37;&#44; respectively&#46; Clinical data of patients receiving immunotherapy are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Forty-six &#40;70&#37;&#41; patients received immunotherapy&#44; 17 &#40;26&#37;&#41; self injectable adrenalin&#44; and two &#40;3&#37;&#41; did not receive any treatment &#40;lost to follow-up&#41;&#46; Clinical data of patients who did not receive immunotherapy are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Thirty-five patients &#40;53&#46;8&#37;&#41; had accompanying atopic disease&#44; 14 of whom had rhinitis&#44; nine had asthma and rhinitis&#44; seven rhinitis&#44; three aspirin-exacerbated respiratory disease and two drug hypersensitivity&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Twelve patients are on the first&#44; 14 on the second&#44; four on the third&#44; eight on the fourth&#44; and five patients are on the fifth year of immunotherapy&#46; Two patients are lost to follow up and one patient left treatment due to financial problems&#46; Twelve patients were restung during immunotherapy and among them only two had systemic reactions&#44; one grade 2&#44; and the other one grade 3&#46; These two patients self injected adrenalin&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Serum Vespula specific IgE class &#40;p&#58;0&#46;02&#41; and Apis specific IgE class were high &#40;p&#60;0&#46;0001&#41; and Apis intradermal test results were positive &#40;p&#60;0&#46;001&#41; in accordance with the patients&#8217; history&#46; However&#44; intradermal test results with Vespula were not consistent with self-reported Hymenoptera type &#40;p&#58;0&#46;15&#41;&#46; Eight out of 25 patients revealed negative skin test result with Vespula&#44; five of whom had positive serum specific IgE&#44; whereas intradermal test with Apis revealed only one negative result out of 15 Apis hypersensitive patients&#46; In patients who underwent immunotherapy&#44; both intradermal tests and serum specific IgE for Apis and Vespula were significantly correlated with immunotherapy bee type &#40;p&#58; 0&#46;04&#44; p&#60;0&#46;0001 and p&#60;0&#46;0001&#44; p&#60;0&#46;0001&#44; respectively&#41;&#46; Vespula venom allergic patients tended to have high values of specific IgE against Apis&#46; While Apis specific IgE and intradermal test results were correlated &#40;rho&#58; 0&#46;59&#44; p&#60;0&#46;0001&#41;&#44; Vespula specific IgE and intradermal test results were not &#40;rho&#58; 0&#46;2&#44; p&#58;0&#46;17&#41;&#46; Intradermal test against Vespula did not discriminate between Apis and Vespula hypersensitive patients&#46; These results suggest that intradermal test for Vespula have limited diagnostic sensitivity&#46; The association between test results and bee type are shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Nineteen patients did not receive immunotherapy&#44; seven of whom were recommended and 12 of whom were not&#46; Twelve patients were not recommended immunotherapy because tests were negative in six&#44; concomitant severe disease was present in four&#44; reaction was a mild urticaria in one&#44; and no reaction in the second sting in one patient&#46; In those 12 patients&#44; self-reported Hymenoptera was vespula in nine&#44; was not known in one and both apis and vespula in two patients&#46; Among 19 patients who did not receive immunotherapy&#44; 17 received self-injectable adrenalin only&#44; 13 of whom had been stung with Vespula&#44; two patients who were recommended immunotherapy with Apis were lost to follow up&#46; The high number of patients in the only self-injectable adrenalin group who had been stung with Vespula also indicates that the diagnostic tests&#44; especially the skin tests with Vespula may have limited diagnostic sensitivity&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">There were no significant differences when grade of reaction and specific IgE and intradermal test results were compared between Apis and Vespula&#46; Serum specific IgE and intradermal test results of Grade 4 reaction were not different from Grade 1-2-3 reactions&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">Honeybees usually do not sting without provocation&#59; they mostly sting in defence of their nest and their queen&#44; whereas yellow jackets tend to sting with minimal provocation&#46; They are highly aggressive and will sting for no apparent reason&#44; particularly in the autumn&#44; when larger populations compete for limited food supplies&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a> Among our Hymenoptera hypersensitive patients&#44; based on self-reported Hymenoptera type&#44; Vespula was responsible for 52&#46;3&#37; of the reactions&#44; and Apis for 27&#46;7&#37;&#46; Previous studies also reported higher incidence of Vespula hypersensitivity&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">For SPT&#44; venom concentrations in the range of 1&#46;0<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;mL are usually performed before intracutaneous tests&#44; but are not used by all allergists&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> Even at 100<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;ml the sensitivity of SPT is lower than that of intradermal test&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> We performed SPT with 1<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;ml venom concentration and only one patient with honeybee allergy was SPT positive&#46; Although our study population is small and we performed SPT with 1<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;ml venom concentration&#44; we can assume that prick testing rarely seems to be positive&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The most striking finding in our study population was the low sensitivity of intradermal test with Vespula&#46; Because of the irritative effect of commercially available venom preparations&#44; concentrations higher than 1<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;ml cannot be used&#46; Low level of specific IgE&#44; however&#44; can lead to systemic reactions&#44; and may not be detected with intradermal testing with 1<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;ml concentration of the Vespula venom preparation&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> Based on our results and previous reports&#44; we recommend that negative skin test responses especially with Vespula&#44; need further investigation&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">We previously reported that a history of seasonal and perennial rhinitis&#44; food allergy&#44; and physician-diagnosed asthma in Turkish beekeepers were associated with systemic sting reactions&#46; The risk of systemic reaction increases approximately threefold when one atopic disease is present and eleven fold when two or more concurrent atopic diseases are present compared to having no atopic disease&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> In this study&#44; 53&#46;8&#37; of our patients had concurrent atopic disease in accordance with our previous finding in beekeepers&#46; M&#252;ller also reported that atopy may increase the risk and severity of systemic reactions in beekeepers and their family members&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> However&#44; Birnbaum et al&#46; reported that the percentage of atopic subjects defined by clinical symptoms and positive skin tests to common aeroallergens was not higher among patients with a history of anaphylactic reaction to Hymenoptera sting than in controls with no such history&#46; They suggested that atopy is not a risk factor for the occurrence of an anaphylactic reaction to Hymenoptera sting&#44; at least among non-beekeepers&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> We think that this issue should be further investigated&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">We analysed our Hymenoptera venom hypersensitive patients and we found some interesting data&#46; However&#44; there are some limitations of our analysis&#46; First&#44; our study population is small&#46; Second&#44; we performed the analysis based on self-reported Hymenoptera type and a considerable number of patients &#40;10&#46;8&#37;&#41; could not remember the responsible Hymenoptera and data of these patients are not included to the analysis&#46; Also&#44; there may have been recall bias&#46; Nevertheless&#44; we showed that if self-reported Hymenoptera is Apis&#44; then the patient&#39;s report is very likely to be true&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">In conclusion&#44; our aim was to determine the characteristics of Hymenoptera venom hypersensitivity and venom immunotherapy practice in Ankara&#44; Turkey&#46; We analysed the data of our patients and found that Vespula venom hypersensitivity was more common among our bee stung patients&#46; Intradermal tests with Vespula have limited diagnostic sensitivity and are not correlated with serum specific IgE&#46; In the case of negative skin test results&#44; especially with Vespula&#44; it should be kept in mind that it is not possible to fully exclude a future sting reaction&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of interest</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors have no conflict of interest to declare&#46;</p></span></span>"
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              "titulo" => "Statistical analysis"
            ]
          ]
        ]
        4 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Results"
        ]
        5 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Discussion"
        ]
        6 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Conflict of interest"
        ]
        7 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2010-08-20"
    "fechaAceptado" => "2010-11-02"
    "PalabrasClave" => array:1 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec74225"
          "palabras" => array:7 [
            0 => "Hymenoptera"
            1 => "<span class="elsevierStyleItalic">Apis Mellifera</span>"
            2 => "<span class="elsevierStyleItalic">Vespula Vulgaris</span>"
            3 => "Venom immunotherapy"
            4 => "Intradermal test"
            5 => "Venom hypersensitivity"
            6 => "Bee allergy"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:1 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Although there are some published data about the prevalence of honeybee and vespid venom allergy from Turkey&#44; there has been no report about Hymenoptera venom immunotherapy practice&#46; Our aim was to determine the characteristics of Hymenoptera venom hypersensitivity and venom immunotherapy practice in Ankara&#44; Turkey&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Demographic and clinical data&#44; intradermal test&#44; and serum specific IgE results of 65 Hymenoptera venom allergic patients who were followed up in our department from February 2005 to August 2009 were analysed&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Serum Vespula specific IgE class &#40;p&#58;0&#46;02&#41; and Apis specific IgE class were high &#40;p&#60;0&#46;0001&#41; and Apis intradermal test results were positive &#40;p&#60;0&#46;001&#41; in accordance with the patients&#8217; history&#46; However&#44; intradermal test results with Vespula were not consistent with self-reported Hymenoptera type &#40;p&#58;0&#46;15&#41;&#46; While Apis specific IgE and intradermal test results were correlated with each other &#40;rho&#58; 0&#46;59&#44; p&#60;0&#46;0001&#41;&#44; Vespula specific IgE and intradermal test results were not &#40;rho&#58; 0&#46;2&#44; p&#58;0&#46;17&#41;&#46; Intradermal test against Vespula did not discriminate between Apis and Vespula hypersensitive patients&#46; There were no significant differences when the grade of reaction and specific IgE and intradermal test results were compared between Apis and Vespula&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Vespula venom hypersensitivity was more common among our patients&#46; However&#44; intradermal tests with Vespula had limited diagnostic sensitivity and were not correlated with serum specific IgE&#46; Based on our results and previous reports&#44; we recommend that negative skin test responses&#44; especially with Vespula&#44; need further investigation&#46;</p>"
      ]
    ]
    "multimedia" => array:3 [
      0 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Descriptive data for categorical and numerical variables were expressed as frequencies and median with range in parenthesis&#44; respectively&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
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                  \t\t\t\t" style="border-bottom: 2px solid black">Vespula&nbsp;\t\t\t\t\t\t\n
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                            3 => "C&#46; Ozkuyumcu"
                            4 => "A&#46;A&#46; Sahin"
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Article information

ISSN: 03010546
Original language: English

DOI:10.1016/j.aller.2010.11.002

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	1	0	1
2024 October	17	6	23
2024 September	11	9	20
2024 August	9	10	19
2024 July	16	6	22
2024 June	12	3	15
2024 May	21	5	26
2024 April	17	4	21
2024 March	14	8	22
2024 February	10	10	20
2024 January	8	9	17
2023 December	16	5	21
2023 November	5	6	11
2023 October	17	17	34
2023 September	25	6	31
2023 August	17	18	35
2023 July	24	10	34
2023 June	18	7	25
2023 May	40	4	44
2023 April	36	6	42
2023 March	33	3	36
2023 February	22	7	29
2023 January	27	11	38
2022 December	44	5	49
2022 November	22	9	31
2022 October	10	5	15
2022 September	16	13	29
2022 August	22	15	37
2022 July	17	16	33
2022 June	19	6	25
2022 May	30	16	46
2022 April	46	9	55
2022 March	93	16	109
2022 February	101	9	110
2022 January	79	7	86
2021 December	47	19	66
2021 November	65	11	76
2021 October	48	14	62
2021 September	25	9	34
2021 August	42	4	46
2021 July	14	13	27
2021 June	10	12	22
2021 May	14	12	26
2021 April	36	34	70
2021 March	17	19	36
2021 February	10	12	22
2021 January	10	12	22
2020 December	1	0	1
2020 November	0	7	7
2020 October	0	3	3
2020 September	0	10	10
2020 August	0	1	1
2020 July	0	2	2
2020 May	0	3	3
2020 April	0	3	3
2020 March	0	4	4
2020 February	0	3	3
2020 January	0	2	2
2019 December	0	4	4
2019 November	0	2	2
2019 October	0	2	2
2019 September	0	9	9
2019 August	0	6	6
2019 July	0	4	4
2019 June	0	16	16
2019 May	0	4	4
2019 April	0	8	8
2019 March	0	1	1
2019 February	0	1	1
2018 December	0	8	8
2018 February	1	1	2
2018 January	3	2	5
2017 December	2	1	3
2017 November	9	4	13
2017 October	2	16	18
2017 September	5	4	9
2017 August	12	8	20
2017 July	6	4	10
2017 June	12	9	21
2017 May	13	12	25
2017 April	9	11	20
2017 March	8	45	53
2017 February	13	5	18
2017 January	9	2	11
2016 December	8	7	15
2016 November	11	4	15
2016 October	24	4	28
2016 September	16	9	25
2016 August	18	4	22
2016 July	6	3	9
2016 June	22	8	30
2016 May	12	5	17
2016 April	15	27	42
2016 March	20	14	34
2016 February	22	16	38
2016 January	16	14	30
2015 December	7	4	11
2015 November	8	4	12
2015 October	15	6	21
2015 September	3	3	6
2015 August	7	1	8
2015 July	6	2	8
2015 June	3	1	4
2015 May	5	2	7
2015 April	7	8	15
2015 March	4	2	6
2015 February	12	2	14
2015 January	14	3	17
2014 December	18	3	21
2014 November	15	2	17
2014 October	13	3	16
2014 September	19	4	23
2014 August	11	1	12
2014 July	6	1	7
2014 June	2	1	3
2014 May	8	2	10
2014 April	1	0	1
2014 March	33	8	41
2014 February	28	7	35
2014 January	40	6	46
2013 December	27	8	35
2013 November	26	10	36
2013 October	29	13	42
2013 September	32	4	36
2013 August	38	7	45
2013 July	28	13	41
2013 June	16	4	20
2013 May	25	6	31
2013 April	22	6	28
2013 March	19	6	25
2013 February	14	5	19
2013 January	12	2	14
2012 December	6	3	9
2012 November	0	2	2
2012 October	2	2	4
2012 January	277	0	277

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Allergologia et Immunopathologia is no longer published on Elsevier since the 2021 year.Transferred to Codon Publications

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