Natural History of Insect Sting Allergy: The Rhode Island Experience
Abstract:The frequency of insect sting allergy in a given population varies depending on the age group of the population and the type of criteria used (history, skin test or RAST). In a pediatric population with a mean age of 13 years (boy scouts), the frequency is 0.8% using history as the only criteria. With this same criteria in an adult population, other authors found the frequency to be higher, 3.3%. The difference is probably due to the prolonged exposure rate to insect stings in adults. Using skin test or RAST as the criteria, the frequency of sting allergy is much higher because of many false-positive reactions. With history alone, the frequency of sting reaction is similar in atopic and nonatopic populations. Sting-sensitive asthmatic patients usually have a severe reaction to a sting with the added symptom of acute bronchospasm. Our RAST studies to venoms revealed that false-positive reactions do occur; a higher frequency of positive reactions occurs within five years of the sting and cross-reactivity among Hymenoptera insects is common except for honey bee. Negative RAST may have more clinical validity than a positive RAST.
Our past and present re-sting data reveal that a large percentage of initially sting-sensitive patients have no reaction on being re-stung. Our new study on untreated sting-sensitive patients revealed that 37% (7/19) had an improved response and 42% (8/19) had the same response on re-sting. Four (21.1%) had a worse reaction. In children under 16 years of age with a cardiovascular/respiratory response on the initial sting, 75% had an improved response on re-sting and of these 63% had no systemic reaction on re-sting and 25% had the same type of reaction. Many other authors reported that a large percentage of children under 16 years old who had a generalized cutaneous reaction to the initial sting had no generalized reaction on re-sting. Those sting-sensitive patients who were re-stung over five years from the initial sting that produced a systemic reaction have more improvement than those re-stung within five years. Although a large percentage of sting-sensitive patients improve without venom desensitization, especially children under 16 years of age, all sting-sensitive patients should be evaluated for possible immunotherapy especially those with cardiovascular/respiratory (Grade III/IV) symptoms and positive skin test or RAST to venoms.
Document Type: Research Article
Publication date: March 1, 1989
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- Allergy and Asthma Proceedings is a peer reviewed publication dedicated to distributing timely scientific research regarding advancements in the knowledge and practice of allergy, asthma and immunology. Its primary readership consists of allergists and pulmonologists.
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