Are Specific Immunoglobulin (IgE and IgG) and Tryptase Levels Correlated with the Severity of Allergic Reactions in Patients with Bee Venom Hypersensitivity?

OBJECTIVES: This review aims to evaluate the clinical utility of specific immunoglobulins (IgE and IgG) and serum tryptase levels as biomarkers for predicting allergic reaction severity in patients with bee venom hypersensitivity. METHODS: A systematic review of nine original cross-sectional and prospective observational studies was conducted. Sample sizes ranged from 30 to over 1,100 participants. The analysis focused on correlations between baseline immunological markers-whole-venom IgE, component-resolved IgE (e.g., Api m 1), IgG/IgG4, and baseline serum tryptase (BST)-and sting reaction severity. RESULTS: Five studies identified elevated BST as the strongest predictor of severe systemic sting reactions and anaphylaxis. In contrast, specific IgE showed limited predictive value whole-venom IgE titers did not correlate with reaction severity, whereas component-resolved IgE (Api m 1) showed potential associations in subgroups such as beekeepers. Baseline IgG and IgG4 levels did not predict clinical severity, although increased IgG4 during venom immunotherapy was associated with protection. Age was identified as a potential risk modifier, but its influence varied across cohorts. CONCLUSION: BST is the most reliable biomarker for risk stratification in bee venom hypersensitivity. Baseline-specific IgE and IgG provide limited prognostic value. Given the heterogeneity of current studies, further standardized prospective research is needed to refine risk assessment protocols for patients with bee venom allergy.