PURPOSE OF THE STUDY.
The authors sought to analyze the clinical features and identify the risk factors associated with children who developed severe systemic reactions to insect sting venom.
A total of 76 Turkish children (57 boys, mean age 9.8 ± 3.4 years) with systemic reactions to Hymenoptera (honeybee or wasp) stings were recruited from a pediatric allergy outpatient center.
Sting victims and their parents identified the insect through wasp and bee picture cards. The extent and severity of the allergic reaction, treatment intervention, and demographic data were documented. Immunoglobulin E (IgE)-mediated venom allergy was identified via allergy skin testing and/or specific IgE testing. Additional evaluation included atopic disease (asthma and/or allergic rhinitis) assessment, aeroallergen skin-prick testing, total IgE level, and eosinophil counts performed at least 2 weeks after the sting reaction.
Overall, 58 (76%) children reacted to Vespula (wasp) stings and 18 (24%) reacted to Apis mellifera (bee) stings. Severe systemic reactions occurred in 45 (59.2%) patients; 20 (26.3%) had aeroallergen sensitization and 25 (32.9%) had atopic disease (allergic rhinitis and/or asthma); 65.8% had experienced previous stings; 95% were admitted to the emergency department; and epinephrine was used in only 46%. The upper limb was the most frequent area stung (43.4%). Cutaneous reaction occurred in 98.9%, but respiratory (74.7%), gastrointestinal (41.3%), and cardiovascular (40.0%) symptoms also occurred. Specific IgE to wasp and bee venom was positive in 87% and 45% of children, respectively, and skin testing to wasp and bee venom was positive in 89% and 37%, respectively. No statistically significant correlations were found between severity of reaction and either testing method. Eosinophilia (>5% eosinophils), female gender, and associated atopic disorder were significant risk factors for severe systemic reactions.
There was a high frequency of hypersensitivity to wasp venom, and severe systemic reactions to Hymenoptera stings are associated with eosinophilia, female gender, and concomitant atopic disease.
At least 40 people in the United States die each year as a result of insect sting anaphylaxis. Approximately 0.34% to 6.5% of children stung by insects experience a systemic reaction. Although not incredibly common, stinging insect anaphylaxis can be an unpredictable and frightening event. This article helps physicians recognize potential risk factors to identify and educate patients on stinging insect avoidance. A potentially disturbing finding that the authors noted was the low usage of epinephrine in the emergency department for treating systemic allergic reactions. Many more lives can potentially be saved with swift intervention of epinephrine, and emergency personnel (emergency medical technicians, nurses, and physicians) need to be aware that, at the proper dosage, the benefits of epinephrine far outweigh its risks in the treatment of severe anaphylaxis.
- Copyright © 2013 by the American Academy of Pediatrics