A prospective pilot study to evaluate the use of hyaluronidase in patients with hymenoptera venom allergy

Abstract Background: Hyaluronic acid-based filler treatments for aesthetic purposes are widespread and constantly increasing in Italy and worldwide. In some specific complications of this filler, its removal by an enzyme, hyaluronidase, which is also one of the components of hymenoptera venom, is indicated. Following the hymenoptera puncture, venom specific IgE antibodies develop, which are the indicators of sensitization, the cause of a possible subsequent fatal anaphylactic reaction, following a new puncture. Aim: the aim of this study is to verify whether hyaluronidase extracted from bovine, used to dissolve hyaluronic acid in case of complications, can cause allergic cross reactions in patients with hymenoptera venom allergy. Methods: Skin tests with hyaluronidase, bee, vespid and hornet poisons were performed, before starting treatment in twenty patients with hymenoptera venom allergy requiring desensitizing therapy (Group A), and in five healthy volunteers (Group B). In Group A patients specific IgE to extracts of the whole venom of Apis mellifera, Vespula spp., Polistes spp. and Vespa crabro were detected, as well as to the molecular components of the same venoms. Results: in all patients of both groups, the skin tests for hymenoptera venom and hyaluronidase gave a negative result, while in Group A patients a positivity to hymenoptera venom was detected and also confirmed with an increase in the specific IgE. Conclusions: the hyaluronidase extracted from bovine utilized for the study did not cause cross reactivity in patients with hymenoptera venom allergy and can be used in complications due to hyaluronic acid-based fillers.