oa Current Allergy & Clinical Immunology - A clinical approach to bee-sting allergy : review article

Volume 18 Number 2
  • ISSN : 1609-3607



Bee-venom hypersensitivity is an important cause of death in highly sensitive individuals. Not all patients who have adverse reactions to bee stings require immunotherapy. The majority of stings produce a localised reaction involving redness, swelling, itching and pain around the sting site. In some cases a large local reaction may persist for days. These patients require symptomatic treatment and no further diagnostic tests are required, as they are not at risk for systemic reactions.

Individuals who experience a systemic reaction (e.g. dizziness, wheezing, generalised urticaria or tightness of the throat) are at risk. They should keep injectable adrenaline on their person and a supply of antihistamines to administer if stung. These individuals are at risk of developing a more serious reaction and should receive bee venom immunotherapy as this will provide more than 85% protection.
Sensitivity can be confirmed using the ImmunoCAP RAST or using a specific skin-prick test. Some patients are CAP RAST positive, but skin-prick test negative.
Bee-venom immunotherapy is given using an updosing regimen over 8-12 weeks, incrementally until a maintenance dose of 100 µg hymenoptera venom is achieved and continued 6-8 weekly for 3-5 years.
Immunotherapy may be stopped after 5 years in most patients even though specific IgE tests remain positive. After completing a course of immunotherapy there is only a 5-10% risk of a systemic reaction and a 2% risk of a reaction requiring epinephrine. Insect allergy in children is believed to be more benign than in adults. Venom immunotherapy has provided protection for up to 20 years.

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