Supplementary Material for: Bee- and Wasp-Venom Sensitization in Schoolchildren of High- and Low-Socioeconomic Status Living in an Urban Area of Indonesia

Background: There is not much known about venom allergy in tropical regions. Here, we studied the prevalence of specific IgE (sIgE) and skin prick test (SPT) reactivity and reported sting-related symptoms, in high- and low-socioeconomic status (SES) schoolchildren living in urban city of Makassar in Indonesia. Methods: Children from high- (n = 160) and low- (n = 165) SES schools were recruited. Standardized questionnaires were used to record information on allergic disorders as well as sting-related symptoms. Parasitic infection, SPT reactivity, and sIgE to Apis mellifera (bee-venom) as well as Vespula spp. (wasp-venom) were assessed. Results: SPT reactivity to bee- and wasp-venom was 14.3 and 12.7%, while the prevalence of sIgE was 26.5 and 28.5%, respectively. When SES was considered, prevalence of SPT to bee- and wasp-venom was higher in high-SES than in low-SES schoolchildren (bee: 22.8 vs. 5.7%, p < 0.001; and wasp: 19.6 vs. 5.7%, p < 0.001). Conversely, sIgE to both venoms was lower in high-SES than in low-SES (bee: 19 vs. 34%, p = 0.016; and wasp: 19 vs. 38%, p = 0.003). Furthermore, among SPT positive subjects, considerable proportion had no detectable sIgE to bee- (65.85%) or wasp-venom (66.67%). Altogether the sensitizations were rarely translated into clinical reaction, as only 1 child reported significant local reaction after being stung. No association with parasitic infections was found. Conclusions and Clinical Relevance: Sensitization against bee- or wasp-venom is quite prevalent among schoolchildren in Indonesia. The discordance between SPT and sIgE might suggest the direct (non-IgE) effect of venoms in skin reactivity. Recorded sensitizations had poor clinical relevance as they rarely translated into clinical symptoms.

背景：热带地区关于毒液过敏的了解甚少。本研究旨在探讨在印度尼西亚马卡萨市居住的高、低收入社会阶层（SES）学校儿童中，特异性IgE（sIgE）和皮内试验（SPT）反应性以及与蛰伤相关的症状的流行情况。方法：招募了来自高（n = 160）和低收入（n = 165）社会阶层学校的儿童。采用标准化问卷记录过敏性疾病以及蛰伤相关症状的信息。评估了寄生虫感染、SPT反应性以及针对Apis mellifera（蜜蜂毒液）和Vespula spp.（黄蜂毒液）的sIgE。结果：对蜜蜂和黄蜂毒液的SPT反应性分别为14.3%和12.7%，sIgE的流行率分别为26.5%和28.5%。当考虑SES时，高SES儿童对蜜蜂和黄蜂毒液的SPT反应率高于低SES儿童（蜜蜂：22.8% vs. 5.7%，p < 0.001；黄蜂：19.6% vs. 5.7%，p < 0.001）。相反，对两种毒液的sIgE在低SES儿童中较高（蜜蜂：19% vs. 34%，p = 0.016；黄蜂：19% vs. 38%，p = 0.003）。此外，在SPT阳性受试者中，相当比例的个体对蜜蜂（65.85%）或黄蜂毒液（66.67%）没有可检测到的sIgE。总的来说，这些致敏反应很少转化为临床反应，只有一名儿童在蛰伤后报告了显著局部反应。未发现与寄生虫感染的相关性。结论和临床相关性：在印度尼西亚儿童中，对蜜蜂或黄蜂毒液的致敏现象十分普遍。SPT与sIgE之间的不一致可能表明毒液在皮肤反应中具有直接的（非IgE）作用。记录的致敏反应临床相关性较差，因为它们很少转化为临床症状。