Food, drug, insect sting allergy, and anaphylaxis
Sensitization to Hymenoptera venoms is common, but systemic sting reactions are rare

https://doi.org/10.1016/j.jaci.2013.10.046Get rights and content

Background

Sensitization to Hymenoptera venom without systemic sting reactions (SSRs) is commonly observed in the general population. Clinical relevance for a future sting has not yet been investigated.

Objective

We aimed to evaluate the effect of these debatable sensitizations with deliberate sting challenges and to monitor serologic changes for up to 2 years.

Methods

One hundred thirty-one challenges with bees and wasps were performed in 94 subjects with a hitherto irrelevant sensitization. The clinical outcome was recorded, and results of specific IgE (sIgE) determinations, skin tests, and basophil activation tests were correlated to the sting reaction. sIgE levels were monitored in reactors and nonreactors after 3 hours, 1 week, 4 weeks, and 1 year.

Results

Only 5 (5.3%) patients had SSRs, but 41 (43.6%) had large local reactions (LLRs) after the sting. Compared with the general population, there was a 9.5-fold higher risk for LLRs but not for SSRs. Three hours after the sting, sIgE levels slightly decreased, but none of the 94 subjects' results turned negative. After 1 week, sIgE levels already increased, increasing up to 3.5-fold (range, 0.2- to 34.0-fold) baseline levels after 4 weeks. To assess the clinical relevance of this increase, we randomly selected 18 patients for a re-sting. Again, 50% had an LLR, but none had an SSR.

Conclusion

Although sensitization to Hymenoptera venoms was common, the risk of SSRs in sensitized subjects was low in our study. The sIgE level increase after the sting was not an indicator for conversion into symptomatic sensitization. Currently available tests were not able to distinguish between asymptomatic sensitization, LLRs, and SSRs.

Section snippets

Subjects

Subjects who tolerated previous Hymenoptera field stings without an SSR were initially screened for sIgE to Hymenoptera venom. Subjects with detectable sIgE to at least 1 Hymenoptera venom who met all other inclusion and exclusion criteria (see Table E1 in this article's Online Repository at www.jacionline.org) were asked to participate in the study. Finally, 110 subjects were enrolled. After a complete health check, including physical examinations, laboratory tests, spirometry, and

History and demographic data

Sixteen of 110 subjects refused sting challenges. Of 94 included subjects, 44 (46.8%) were male, and 50 (53.2%) were female. Median age was 29.0 (25% to 75% percentile, 24.0-40.3 years). Forty-eight (51.1%) were considered to have an atopic predisposition, and 27 (28.7%) reported previous LLRs caused by Hymenoptera stings.

Outcome of sting challenges

Finally, 131 sting challenges with bees, wasps, or both were performed in 94 subjects. Forty-one were stung by a bee, 16 by a wasp, and 37 by both a bee and a wasp. Only 6

Discussion

Positive test results to Hymenoptera venom despite a negative history are a well-known phenomenon in the general population. In older studies with IgE determination on the RAST platform, 27.1% were reported to have sIgE to Hymenoptera venoms,4 and using the refined fluorescence enzyme assay (ImmunoCAP), 40.7% had detectable sIgE to any Hymenoptera venom.5 In the initial phase of this study, 44.1% of all screened subjects had positive results. This rate of sensitization is quite high and cannot

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    Supported by a grant from the Austrian Society for Dermatology and Venereology.

    Disclosure of potential conflict of interest: G. J. Sturm has received research support from OEGDV and has received lecture fees from ALK-Abelló. C. Schuster has received lecture fees from the Austrian Workers' Compensation Board and ALK-Abelló. The rest of the authors declare that they have no relevant conflicts of interest.

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