Almost all of us have a fear of being stung by a bee or wasp. This fear may stem from the pain often associated with the sting or from the knowledge that such a sting may be life threatening for some people. The statistics show that approximately 40-100 people die per year in the USA from insect sting anaphylaxis. This gives an overall incidence of 0.4-3% of the American population. The majority of stings occur in those under 20yrs, but the majority of deaths occur in adults due to the profound physiologic changes that can occur with anaphylaxis. Almost all physicians are aware of the severe reactions that can occur with venom hypersensitivity, but many are unaware of the options a patient may have for treatment.

A brief introduction into the cast of characters... There are five stinging insects that fall under the classification of hymenoptera; honeybee, bumblebee, yellowjacket, hornet and wasp. Prior to 15 years ago, physicians thought that whole body extracts were efficatious. It is now clear that the allergens in the hymenoptera are in the venom. The first step in the proper treatment of venom hypersensitivity is to properly classify a sting reaction. A local reaction may range from a small area of erythema to a large area of swelling that evolves over 1-2 days. I often tell people that if you have swelling up to two joints from the site of sting then you have a large local reaction.A systemic reaction can involve hives, angioedema, bronchospasm, laryngeal edema, hypotension and shock. The development of sensitivity varies from individual to individual. One person may become sensitized after 1 sting and another may be repeatedly stung for years before becoming sensitive. People at risk for anaphylaxis often make substantial changes in their lifestyle and live in fear of re-stings. The proper guidance and treatment of venom hypersensitivity first requires environmental control measures. This includes advice such as not walking barefoot, checking before drinking from an opened soda can at a picnic and carrying emergency meds if known to be allergic. If a person has any kind of systemic reaction, then they may be a candidate for venom testing and a medic alert bracelet. It appears that a person will tend to have the same reaction to a sting that they had initially. Any adult with a systemic reaction is a candidate for venom testing. Children under 16yo with hives only don’t require further evaluation. There have been several studies showing that these children are not at risk for any other reaction, besides dermal. Venom skin testing is 99% sensitive and 80% specific. Most people are unable to properly identify what stung them, therefore, the patient is usually tested to the 5 stinging insects.

Venom immunotherapy is truly one of the success stories in medicine. Since 1979 we have the venom available to effectively treat patients. Efficacy has been cited between 95-99%. Studies have shown patients develop protective titers as early as 3 months. Venom immunotherapy is usually handled in a "rush" fashion. This means that patients will receive several injections in one week to help facilitate the development of protective titers quickly. Once a patient has gone through the build up there is a much lower risk of anaphylaxis. The duration of venom immunotherapy is still controversial, but most allergist would recommend a 5 year plan in those patients with mild or moderate systemic reactions. Some allergist would recommend indefinite immunotherapy for those with cardiovascular instability from a venom sting. The bottom line is venom immunotherapy is very beneficial and can be life saving.