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However, laboratory diagnosis is difficult as the pure venom and diagnostic reagents are not commercially available.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>This study assessed the use of four recombinant allergens of<jats:italic>A. mellifera<\/jats:italic>venom and the passive basophil activation test in the diagnosis of<jats:italic>A. dorsata<\/jats:italic>venom anaphylaxis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Serum IgE levels to four recombinant allergens of<jats:italic>A. mellifera<\/jats:italic>, rApi m 1, 2, 5 and 10 were assessed and compared with serum IgE to the crude venom of<jats:italic>A. mellifera<\/jats:italic>or<jats:italic>V. vulgaris<\/jats:italic>by Phadia ImmunoCAP, in patients who developed anaphylaxis to<jats:italic>A. dorsata<\/jats:italic>stings. Basophil activation in response to venom of<jats:italic>A. dorsata<\/jats:italic>or<jats:italic>V. affinis<\/jats:italic>was assessed using a passive basophil activation test. Association of the severity of the reaction with basophil activation was compared.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>rApi m 1 and 10 combinedly had significant correlation (r\u2009=\u20090.722; p\u2009&lt;\u20090.001) with the crude venom of<jats:italic>A. mellifera<\/jats:italic>(Western honeybee) and a higher positivity rate of 90% (27\/30). Whereas, IgE reactivity to rApi m 2 or 5 had significant correlation (p\u2009=\u20090.02 and p\u2009=\u20090.005 respectively) with<jats:italic>V. vulgaris<\/jats:italic>crude venom. All 30 (100%) were positive to<jats:italic>A. dorsata<\/jats:italic>venom in passive BAT; 70% (21\/30) had over 80% activation, 96.7% (29\/30) had over 60% activation and 100% had over 50% activation. Percentage activation of basophils in patients who had mild or moderate reactions (n\u2009=\u200920) was significantly low (p\u2009=\u20090.02) from that of patients who had severe reactions (n\u2009=\u200910).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>rApi m 1 and 10 when combined was sensitive for the diagnosis of<jats:italic>A. dorsata<\/jats:italic>allergy. This combination had the lowest cross-reactivity rate with<jats:italic>Vespula vulgaris<\/jats:italic>. The passive BAT is highly sensitive in<jats:italic>A. dorsata<\/jats:italic>allergy. The basophil reactivity was significantly higher in severe anaphylaxis compared to mild\/moderate anaphylaxis. This finding should be further explored in further studies.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s12948-022-00178-9","type":"journal-article","created":{"date-parts":[[2022,9,14]],"date-time":"2022-09-14T18:02:57Z","timestamp":1663178577000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Diagnosis of Apis dorsata venom allergy: use of recombinant allergens of Apis mellifera and a passive basophil activation test"],"prefix":"10.1186","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7017-520X","authenticated-orcid":false,"given":"Peshala","family":"Gunasekara","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S. 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