The main causes of death due to anaphylaxis are airway obstruction and cardiovascular failure rarer causes are disseminated intravascular coagulation (DIC) and epinephrine overdose ( 7). Most patients recover without any permanent sequelae. The severity of anaphylaxis is graded on the basis of its clinical manifestations ( Table 1). The reaction usually arises 10 to 30 minutes after the sting, although the latency may be shorter or longer. In the great majority of cases, a single sting is the cause. Specific IgE antibodies directed against components of the toxin mediate the activation of mast cells and basophilic granulocytes, leading to the release of mediators that cause the acute manifestations of disease. With respect to its pathogenesis, Hymenoptera-toxin anaphylaxis is a typical immediate-type allergic reaction. The reaction can be fatal: in Germany, the official statistics include about 20 fatal Hymenoptera stings each year, but the real number may be much higher, as anaphylaxis is often not recognized as such ( e3, e4). Adults most commonly experience severe anaphylaxis after being stung by Hymenoptera, mainly wasps ( 6). The major emphasis of this article is on diseases caused by bee and wasp stings, in view of their clinical importance.Ī recently issued S2 guideline on this subject contains ratings of the pertinent literature by evidence level (, AWMF registration number 061–020 see the website ).Īnaphylaxis induced by bee and wasp stingsĪnaphylaxis induced by a bee or wasp sting is a common problem that affects 1.2% to 3.5% of all people at some point in their lives ( 5). Such reactions are very rarely induced by the stings of ants (which also belong to the order Hymenoptera) or other insects, such as mosquitoes. Anaphylaxis is occasionally caused by other species of Vespidae, such as Dolichovespula spp., hornets ( Vespa crabro), and bees (mainly bumblebees ). They are most commonly caused by honeybees ( Apis mellifera, hereafter designated simply bees) and certain species of wasp in the family Vespidae (particularly Vespula vulgaris and V. IgE-mediated systemic allergic reactions are of far greater clinical significance induced by the stings of insects belonging to the order Hymenoptera, they are associated with an immediate (anaphylactic) response that can have fatal consequences. Most patients with systemic anaphylactic reactions to bee or wasp stings need specific immunotherapy.Ĭaused by insects with poisonous stingers or salivary secretions of blood-sucking insects Patients who have had a systemic reaction or a large local reaction due to insect allergy must take permanent measures to avoid further allergen contact, and to make sure they can treat themselves adequately if stung again. The acute symptoms of an insect sting are treated symptomatically. Large local reactions may ensue, but other diseases are rare. Blood-sucking by hematophagous insects can elicit a local allergic reaction, presenting as a wheal or papule, in at least 75% of the population. Mastocytosis is found in 3% to 5% of patients with sting anaphylaxis, rendering these patients prone to very severe reactions. Large local reactions are due to allergy and occur in up to 25% of the population as many as 3.5% develop IgE-mediated, potentially life-threatening anaphylaxis, of which about 20 people die in Germany each year. Insect venom induces a toxic reaction at the site of the sting.
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