A recent venom allergy guideline¹ published by the British Society for Allergy and Clinical Immunology (BSACI) this year, makes interesting reading. They report a lifetime-risk between 60 and 90% for the UK population of being stung by a wasp (Vespid) or bee (Apis). Of those stung, up to 26% will report large painful local reactions, but significant allergic reactions only occur in about 7% of those stung (bee-keepers being a very high-risk group with severe reactions reported in 30% of those stung). Although wasp venom allergy is more common in the UK, bee-stings carry a higher risk for anaphylaxis. Any patient with a severe reaction to an insect sting should be tested for both bee and wasp venoms sensitivity, as dual-positive IgE antibodies to both insects occurs in 30%, even though they may report being clinically sensitive to only one insect. Venom desensitisation immunotherapy (VIT) or “allergy shots” are highly effective in those severely sensitive to insect stings, resulting in a cure for 95% of wasp and 80% of bee venom allery sufferers treated over the 3 year programme. Older people are more likely to develop life-threatening anaphylaxis and fatal allergic reactions (at an average age of 50 years). Children are less prone to have life-threatening allergic reactions to insects, and 80% of children with a mild venom allergy with tolerate further stings and outgrow their allergy. Once sensitised, reactions are likely to be the same in 45% stings, milder in 43% and more severe in only 12%. Fatal reactions after insect stings are rare (47 deaths in UK over a 10 year period from 1992-2001)
¹Reference: Krishna MT, Ewan PW, Diwakar L, Durham S, Frew AJ, Leech SC and Nasser SM. Diagnosis and management of hymenoptera venom allergy: British Society for Allergy and Clinical Immunology (BSACI) guidelines. Clinical and Experimental Allergy 2011:41; 1201-1220
