HONEYBEE VENOM IMMUNOTHERAPY

FCAAIA Notes:  Although this article reviews honey bee allergy and treatment, most of what it says in all sections also applies to the other flying insects that sting (wasps, yellow jackets, hornets) and fire ants (collectively known as hymenoptera).

Hymenoptera allergy might be the most curable thing we see in our practice.  Its treatment goes well beyond carrying self-injectable epinephrine.  If you or a loved one has ever had a systemic reaction to a flying insect sting (any reaction away from the sting itself) and has not been evaluated by an allergist, call now for an appointment.

(Source: http://www.medscape.com/viewarticle/778244_1   March 14, 2013. Adapted from Immunotherapy. 2012;4(11):1153-1166. For Medscape articles: User name: FCAAIA, Password: Allergies)

Abstract

The honeybee is an interesting insect because of the fundamental agricultural role it plays, together with the composition of its venom, which presents new diagnostic and immunotherapeutic challenges. This article examines various aspects of honeybee venom allergy from epidemiology to diagnosis and treatment, with special emphasis on venom immunotherapy (VIT). Honeybee venom allergy represents a risk factor for severe systemic reaction in challenged allergic patients, for the diminished effectiveness of VIT, for more frequent side effects during VIT and relapse after cessation of treatment. Some strategies are available for reducing the risk of honeybee VIT-induced side effects; however, there is considerable room for further improvement in these all-important areas. At the same time, sensitized and allergic beekeepers represent unique populations for epidemiological, venom allergy immunopathogenesis and VIT mechanism studies.

Introduction

Hymenoptera stings can cause severe systemic allergic reactions and occasionally fatal anaphylaxis. The offending Hymenoptera belong to the Vespidae (Vespinae and Polistinae subfamilies) and Apoidea superfamilies. The latter superfamily includes honeybees (HBs; Apis mellifera), which are brown in color and moderately hairy, and bumblebees (genus Bombus), which are larger than honeybees, much hairier and characterized by distinct alternate yellow and white bands on their abdomen.[1]

This article aims to provide a focused understanding of the uniqueness of HB venom allergy, with special emphasis on venom immunotherapy (VIT).

Available epidemiological data on HB stings are thin on the ground. Up to 94.5% of interviewees recalled receiving one Hymenoptera sting, which was climate-related, one-third of which were from HBs, at least as far as Europe is concerned.

The estimated prevalence of sensitization is between 9.3 and 28.7% in adults. HB-specific IgE was found in 3.7 to 16% in all adults. One study which revealed a much higher sensitivity to HB venom (HBV) was based on a pediatric population in which only a skin prick test was done. The prevalence of large local reactions (LLRs) in the general population ranges from 2.4 to 26.4%. Although this may be, there are no separate data for HBs.

According to European and American population-based studies, the lifetime prevalence of a systemic reaction (SR) to Hymenoptera ranges from 0.3 to 7.5% in adults, which is lower in children, and related to factors of geography, the study population, the venoms used for diagnosis and the subject’s profession and hobbies. In a recent Spanish epidemiological study on a general population, the HB caused 45.5% of all reactions.

Hymenoptera stings were responsible for about 20% of cases of biphasic anaphylaxis where it was not possible to determine the exact role of HB stings.

HB-sting fatalities have never been studied as a separate entity, though extrapolation of the literature clearly shows the diverse role of HB stings. Data from the UK and Florida (USA) yielded a lower percentage of HB-sting fatalities than vespid-sting deaths,while a Costa Rican study reported that HB stings were mainly responsible.

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