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Hymenoptera venom immunotherapy: Efficacy, indications, and mechanism of action

Author
David F Graft, MD
Section Editor
David B Golden, MD
Deputy Editor
Anna M Feldweg, MD

INTRODUCTION

Systemic allergic reactions to the venom of insects in the order Hymenoptera (which includes bees, yellow jackets, wasps, hornets, and fire ants) can be life-threatening. Immunotherapy for venom allergy has been available for over four decades and is highly effective. Unfortunately, many patients with sting-induced anaphylactic reactions are not referred to an allergist/immunologist for evaluation and are never offered this potentially lifesaving therapy [1].

The indications for treatment with venom immunotherapy (VIT), as well as patient selection, effectiveness, and mechanism of action, will be reviewed here. Protocols and safety of VIT and the diagnosis of venom allergy are discussed separately. (See "Hymenoptera venom immunotherapy: Technical issues, protocols, adverse effects, and monitoring" and "Diagnosis of Hymenoptera venom allergy".)

TYPES OF REACTIONS TO HYMENOPTERA STINGS

There are three common types of allergic reactions to Hymenoptera sting: anaphylactic reactions, cutaneous systemic reactions, and large local reactions. These are reviewed briefly here and discussed in more detail elsewhere. (See "Bee, yellow jacket, wasp, and other Hymenoptera stings: Reaction types and acute management" and "Stings of imported fire ants: Clinical manifestations, diagnosis, and treatment".)

An anaphylactic reaction involves signs and symptoms of immunoglobulin E (IgE)-mediated allergy, typically affecting more than one organ system (table 1). The skin (urticaria and angioedema) is commonly involved, but respiratory or circulatory symptoms are also prominent. Some of the most severe reactions (eg, sudden hypotension) occur in the absence of any skin findings or can be refractory to single or multiple doses of epinephrine [2-4].

A cutaneous systemic reaction (or a generalized cutaneous reaction) consists of signs and symptoms limited to the skin (ie, pruritus, erythema, urticaria, and/or angioedema), which is usually widespread and involves skin that is not contiguous with the sting site. Reactions involving angioedema of the tongue or throat, which could compromise the airway, are generally excluded from this category and considered anaphylactic reactions [5].

                     

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Literature review current through: May 2017. | This topic last updated: Apr 14, 2017.
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