Insect Sting Allergy in Adults

  • Anne K. Ellis
  • James H. Day
Part of the Allergy Frontiers book series (ALLERGY, volume 3)


Reactions to insect stings vary from a usual small painful swelling at the site to a large local reaction which may involve an entire limb secondary to a late phase allergic response. These alone do not predict future systemic reactions. Systemic reactions, even mild ones are mostly due to specific IgE responses to venom and may be life-threatening. These should be managed immediately and be followed up for possible specific venom immunotherapy (VIT).

Most stings occur away from emergency facilities thus immediate recognition of the event and proper management is essential. Yellow jackets are the main culprits in the general population followed up by honey bees especially among workers in the industry. Other stinging insects include various wasps, hornets, and in southern climates, fire ants. Africanized bees, because of their aggressive nature are a likely source of stings where they occur.

Epinephrine by intramuscular injection is regarded as the treatment of choice for anaphylactic responses followed up by antihistamines alone or in combination with corticosteroids. Auto-injectors of epinephrine should be prescribed and their use is clearly demonstrated under the supervision of a physician or a trained nurse. There is a 20% incidence of second-phase anaphylactic reactivity, and patients need to be warned and monitored for this development.

Patients having systemic reactions should be referred to an Allergy Specialist for evaluation and, if indicated, specific VIT. VIT is usually limited to 3–5 years in most patients with mild to moderate anaphylactic reactions supported by evidence of specific venom allergy, but long term or even life-long treatment may be considered in those whose reaction was particularly severe especially in a setting where future stings are likely. For persons at risk of sting reactions such as agricultural workers, those working in the bee industry and their family members while undergoing VIT, emergency kits containing epinephrine auto-injectors should be reasonably available.


Allergy Clin Immunol Hymenoptera Venom Insect Sting Honeybee Venom Yellow Jacket 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Moffitt JE, Golden DBK, Reisman RE, Lee R, Nicklas R, et al. Stinging insect hypersensitiv-ity: a practice parameter update. J Allergy Clin Immunol. 2004 Oct; 114: 869–86.PubMedGoogle Scholar
  2. 2.
    Hoffman DR, Jacobson RS. Allergens in Hymenoptera venom. XII. How much protein in a sting? Ann Allergy 1984; 52: 276–78.PubMedGoogle Scholar
  3. 3.
    Guralnick MW, Benton AW. Entomological aspects of insect sting allergy. In: Levin MI, Lockey RF, eds. Monograph on insect allergy. 4th ed. Milwaukee, WI: American Academy of Allergy, Asthma and Immunology, 2003: pp. 11–26.Google Scholar
  4. 4.
    Goddard J. Physician's guide to arthropods of medical importance. 4th ed. Boca Raton, FL.: CRC Press, 2003: p. 4.Google Scholar
  5. 5.
    Barnard JH. Studies of 400 Hymenoptera sting deaths in the United States. J Allergy Clin Immunol 1973; 52: 259–64.PubMedGoogle Scholar
  6. 6.
    Day JH, Buckeridge DL, Welsh AC. Risk assessment in determining systemic reactivity to honeybee stings in sting-threatened individuals. J Allergy Clin Immunol 1994; 93: 691–705.PubMedGoogle Scholar
  7. 7.
    McKenna WR. Africanized honeybees. In: Levin MI, Lockey RF, eds. Monograph on insect allergy. 4th ed. Milwaukee, WI: American Academy of Allergy, Asthma and Immunology, 2003: pp. 27–36.Google Scholar
  8. 8.
    Hamilton, RG. Diagnosis of Hymenoptera venom sensitivity. Curr Opinion Allergy Immunol 2002; 2: 347–51.Google Scholar
  9. 9.
    Kemp SF. deShazo RD, Moffitt JE, et al. Expanding habitat of the imported fire ant (Solenopsis invicta): a public health concern. J Allergy Clin Immunol 2000; 105: 683–91.Google Scholar
  10. 10.
    Kemp SF, deShazo RD, Moffitt JE, Williams DF, Buhner WA 2nd. Expanding habitat of the imported fire ant (Solenopsis invicta): a public health concern. J Allergy Clin Immunol 2000; 105: 683–91.PubMedGoogle Scholar
  11. 11.
    deShazo RD, Williams DF, Moak ES. Fire ant attacks on residents in health care facilities: a report of two cases. Ann Intern Med 1999; 131: 424–9.PubMedGoogle Scholar
  12. 12.
    Ellis AK, Day JH. Allergy to insect bites and stings. Allergy 1996; 9(3): 18–22.Google Scholar
  13. 13.
    Tracy JM, Demain JG, Quinn J.M., et al. The natural history of exposure to the imported fire ant, J Allergy Clin Immunol 1995; 95: 824–828.PubMedGoogle Scholar
  14. 14.
    Caplan EL, Ford JL, Young PF, Ownby DR. Fire ants represent an important risk for anaphy-laxis among residents of an endemic region. J Allergy Clin Immunol 2003; 111: 1274–7.PubMedGoogle Scholar
  15. 15.
    Solley GO. Stinging and biting insect allergy: an Australian experience. Ann Allergy Asthma Immunol 2004; 93: 532–37.PubMedGoogle Scholar
  16. 16.
    Yates AB, Moffitt JE, deShazo RD: Anaphylaxis to arthropod bites and stings. Immunol Allergy Clin North Am 2001; 21: 635–51.Google Scholar
  17. 17.
    Leveau P. Risk factors for allergy to hymenoptera stings Allerg Immunol (Paris) 1993; 25: 220, 224–6.Google Scholar
  18. 18.
    Fernandez J, Soriano V, Mayorga L, Mayor M. Natural history of Hymenoptera venom allergy in Eastern Spain. Clin Exp Allergy 2005; 35: 179–85.PubMedGoogle Scholar
  19. 19.
    Dubois AE. Mastocytosis and Hymenoptera allergy. Curr Opin Allergy Clin Immunol 2004; 4: 291–5.PubMedGoogle Scholar
  20. 20.
    Golden D. Insect allergy. In: Adkinson NF Jr, Yunginger JW, Busse WW, Bochner BS, Holgate ST, Simons FER, eds. Middleton's allergy: principles & practice. 4th ed. Vol. 2. Philadelphia, PA: Mosby, 2003: pp. 1475–86.Google Scholar
  21. 21.
    Golden DBK. Insect sting allergy and venom immunotherapy: a model and a mystery. J Allergy Clin Immunol 2005; 115: 439–47.PubMedGoogle Scholar
  22. 22.
    Mauriello PM, Barde SH, Georgitis JW, et al. Natural history of large local reactions from stinging insects. J Allergy Clin Immunol 1984; 74: 494–498.PubMedGoogle Scholar
  23. 23.
    Ellis AK, Day JH. Diagnosis and management of anaphylaxis. Can Med Assoc J 2003; 169(4): 307–12.Google Scholar
  24. 24.
    Stark BJ, Sullivan TJ. Biphasic and protracted anaphylaxis. J Allergy Clin Immunol 1986; 78: 76–83.PubMedGoogle Scholar
  25. 25.
    Ellis AK, Day JH. A prospective evaluation of 103 patients with biphasic anaphlyaxis. J Allergy Clin Immunol 2004; 113: S259 [Abs 935].Google Scholar
  26. 26.
    Ellis AK, Day JH. Incidence and characteristics of biphasic anaphylaxis: a prospective evaluation of 103 patients. Ann Allergy Asthma Immunol. 2007; 98: 64–9.PubMedGoogle Scholar
  27. 27.
    Gabriel DP, Rodrigues AG Jr, Barsante RC, dos Santos Silva V, Caramori JT, Martim LC, Barretti P, Balbi AL. Severe acute renal failure after massive attack of Africanized bees. Nephrol Dial Transplant. 2004; 19: 2680.PubMedGoogle Scholar
  28. 28.
    Daher Ede F, da Silva Junior GB, Bezerra GP, Pontes LB, Martins AM, Guimaraes JA. Acute renal failure after massive honeybee stings. Rev Inst Med Trop Sao Paulo. 2003; 45: 45–50.Google Scholar
  29. 29.
    Reisman R, Livingston A, Late onset allergic reactions including serum sickness after insect stings. J Allergy Clin Immunol 1989; 84: 331–7.PubMedGoogle Scholar
  30. 30.
    Moffitt JE. Allergic reactions to insect stings and bites. South Med J 2003; 96: 1073–9.PubMedGoogle Scholar
  31. 31.
    Chen DM, Lee PT, Chou KJ, Fang HC, Chung HM, Chen DM, Chang LK. Descending aortic thrombosis and cerebral infarction after massive wasp stings. Am J Med. 2004; 116: 567–9.PubMedGoogle Scholar
  32. 32.
    Boz C, Velioglu S, Ozmenoglu M. Acute disseminated encephalomyelitis after bee sting. Neurol Sci. 2003; 23: 313–5.PubMedGoogle Scholar
  33. 33.
    Likittanasombut P, Witoonpanich R, Viranuvatti K. Encephalomyeloradiculopathy associated with wasp sting. J Neurol Neurosurg Psychiatr 2003; 74: 134–135.PubMedGoogle Scholar
  34. 34.
    Gawlik R, Rymarczyk B, Rogala B. A rare case of intravascular coagulation after honey bee sting. J Investig Allergol Clin Immunol. 2004; 14: 250–2.PubMedGoogle Scholar
  35. 35.
    Sheth HG, Sullivan TJ. Optic neuropathy and orbital inflammatory mass after wasp stings. J R Soc Med 2004; 97: 436–7.PubMedGoogle Scholar
  36. 36.
    Carr ME. Hand-foot syndrome in a patient with multiple fire ant stings. South Med J. 2004; 97: 707–9.PubMedGoogle Scholar
  37. 37.
    Kalogeromitros D, Gregoriou S, Papaioannou D, Mousatou V, Makris M, Katsarou-Katsari A. Acquired primary cold contact urticaria after Hymenoptera sting. Clin Exp Dermatol. 2004; 29: 93–5.PubMedGoogle Scholar
  38. 38.
    Panagariya A, Sharma B, Garg A. Oculopalatal syndrome with ataxia following hymenoptera sting. J Assoc Physicians India 2003; 51: 1007–8.PubMedGoogle Scholar
  39. 39.
    Lin CC, Chang M Y, Lin JL. Hornet sting induced systemic allergic reaction and large local reaction with bulle formation and rhabdomyolysis. J Toxicol Clin Toxicol 2003; 41: 1009–11.PubMedGoogle Scholar
  40. 40.
    Kim YO, Yoon SA, Kim KJ, Lee BO, Kim BS, Chang YS, Bang BK. Severe rhabdomyolysis and acute renal failure due to multiple wasp stings. Nephrol Dial Transplant. 2003; 18: 1235PubMedGoogle Scholar
  41. 41.
    Fisher BA, Antonios TF. Atrial flutter following a wasp sting. J Postgrad Med. 2003; 49: 254–5.PubMedGoogle Scholar
  42. 42.
    Mauriello PM, Barde SH, Georgitis JW, et al. Natural history of large local reactions from stinging insects. J Allergy Clin Immunol 1984; 74: 494–498.PubMedGoogle Scholar
  43. 43.
    Freeman TM. Hypersensitivity to Hymenoptera stings. New Engl J Med 2004; 351(19):1978–84.PubMedGoogle Scholar
  44. 44.
    Chamberlain D. Emergency medical treatment of anaphylactic reactions. Project Team of the Resuscitation Council (UK). J Accid Emerg Med 1999; 16(4): 243–7.PubMedGoogle Scholar
  45. 45.
    Simons FER, Gu X, Simons KJ. Epinephrine absorption in adults: intramuscular versus subcutaneous injection. J Allergy Clin Immunol 2001; 108(5): 871–3.PubMedGoogle Scholar
  46. 46.
    Anchor J, Settipane RA. Appropriate use of epinephrine in anaphylaxis. Am J Emerg Med 2004; 22: 488–90.PubMedGoogle Scholar
  47. 47.
    Shaver KJ, Adams C, Weiss SJ. Acute myocardial infarction after administration of low-dose intravenous epinephrine for anaphylaxis. CJEM. 2006; 8: 289–94.PubMedGoogle Scholar
  48. 48.
    Lieberman P. The use of antihistamines in the prevention and treatment of anaphylaxis and anaphylactoid reactions. J Allergy Clin Immunol 1990; 86(4 Pt 2): 684–6.PubMedGoogle Scholar
  49. 49.
    Stark BJ, Sullivan TJ. Biphasic and protracted anaphylaxis. J Allergy Clin Immunol 1986; 78 (1 Pt 1): 76–83.PubMedGoogle Scholar
  50. 50.
    Ellis AK, Day JH. Biphasic anaphylaxis with unusually late onset second phase: a case report. Can J Allergy Clin Immunol 1997; 2(3): 106–9.Google Scholar
  51. 51.
    Greenberger PA. Contrast media reactions. J Allergy Clin Immunol 1984; 74: 600–5.PubMedGoogle Scholar
  52. 52.
    Grouhi M, Alshehri M, Hummel D, Roifman CM. Anaphylaxis and epinephrine auto-injector training: who will teach the teachers? J Allergy Clin Immunol 1999; 104: 190–3.PubMedGoogle Scholar
  53. 53.
    Gold MS, Sainsbury R. First aid anaphylaxis management in children who were prescribed an epinephrine autoinjector device (Epipen). J Allergy Clin Immunol 2000; 106: 171–6.PubMedGoogle Scholar
  54. 54.
    DeShazo R, Butcher B, Banks W. Reactions to stings of the imported fire ant. N Engl J Med 1990; 323: 462–6.PubMedGoogle Scholar
  55. 55.
    Reisman R, Insect stings. N Engl J Med 1994; 331: 523–7.PubMedGoogle Scholar
  56. 56.
    Valentine M, Schuberth K, Kagey-Sobotka A. The value of immunotherapy with venom in children with allergy to insect stings. N Engl J Med 1990; 323: 1601–3.PubMedGoogle Scholar
  57. 57.
    Freeman TM, Hylander R, Ortiz A, Martin M, Imported fire ant immunotherapy: effectiveness of whole body extracts. J Allergy Clin Immunol 1992; 90: 210–5.PubMedGoogle Scholar
  58. 58.
    Tankersley MS, Walker RL, Butler WK, Hagan LL, et al. Safety and efficacy of an imported fire ant rush immunotherapy protocol with and without prophylactic treatment. J Allergy Clin Immunol 2002; 109: 556–62.PubMedGoogle Scholar
  59. 59.
    Freeman TM, Hylander R, Ortiz A, Martin M, Imported fire ant immunotherapy: effectiveness of whole body extracts. J Allergy Clin Immunol 1992; 90: 210–5.PubMedGoogle Scholar
  60. 60.
    Stafford C. Hypersensitivity to fire ant venom. Ann Allergy 1996; 77: 87–99.Google Scholar
  61. 61.
    Creticos PS, Franklin Adkinson N Jr, Kagey-Sabotka A, et al. Nasal challenge with ragweed in hay fever patients: effect of immunotherapy. J Clin Invest 1985; 76: 2247–53.PubMedGoogle Scholar
  62. 62.
    Jutel M, Müller UR, Fricker M, et al. Influence of bee venom immunotherapy on degranulation and leukotriene generation in human blood basophils. Clin Exp Allergy 1996; 26: 1112–8.PubMedGoogle Scholar
  63. 63.
    Bellinghausen I, Metz G, Enk AH, et al. Insect venom immunotherapy induces interleukin-10 production and a Th2-to-Th1 shift, and changes surface marker expression in venom-allergic subjects. Eur J Immunol 1997; 27: 1131–9.PubMedGoogle Scholar
  64. 64.
    Jutel M, Pichler WJ, Skrbic D, et al. Bee venom immunotherapy results in decrease of IL-4 and IL-5 and increase of IFN-γ secretion in specific allergen stimulated T cell cultures. J Immunol 1995; 154: 4178–94.Google Scholar
  65. 65.
    Akdis CA, Akdis M, Blesken T, et al. Epitope specific T cell tolerance to phospholipase A2 in bee venom immunotherapy and recovery by IL-2 and IL-15 in vitro. J Clin Invest 1996; 98: 1676–83.PubMedGoogle Scholar
  66. 66.
    Akdis CA, Blaser K. IL-10 induced anergy in peripheral T cell and reactivation by microen-vironmental cytokines: two key steps in specific immunotherapy. FASEB J 1999; 13: 603–9.PubMedGoogle Scholar
  67. 67.
    Akdis CA, Blesken T, Wymann D, et al. Differential regulation of human T cell cytokine patterns and IgE and IgG4 responses by conformational antigen variants. Eur J Immunol 1998; 28: 914–25.PubMedGoogle Scholar
  68. 68.
    Müller UR, Akdis CA, Fricker M, et al. Successful immunotherapy with T cell epitope peptides of bee venom phospholipase A2 induces specific T cell anergy in bee sting allergic patients. J Allergy Clin Immunol 1998; 101: 747–54.PubMedGoogle Scholar
  69. 69.
    Carballido JM, Carballido-Perrig N, Kägi MK, et al. T cell epitope specificity in human allergic and non-allergic subjects to bee venom phospholipase A2. J Immunol 1993; 150: 3582–91.PubMedGoogle Scholar
  70. 70.
    Akdis CA, Blesken T, Akdis M, et al. Role of IL-10 in specific immunotherapy. J Clin Invest 1998; 102: 98–106.PubMedGoogle Scholar
  71. 71.
    Jonuleit H, Schmitt E, Stassen M, et al. Identification and functional characterization of human CD4+CD25+ T cells with regulatory properties isolated from peripheral blood. J Exp Med 2001; 193: 1285–90.PubMedGoogle Scholar
  72. 72.
    Suri-Payer E, Amar AZ, Thornton AM, Shevach EM. CD4+CD25+ T cells inhibit both the induction and effector function of autoreactive T cells and represent a unique lineage of immunoregulatory cells. J Immunol 1998; 160: 1212–18.PubMedGoogle Scholar
  73. 73.
    Thornton AM, Shevach EM. CD4+CD25+ immunoregulatory T cells suppress polyclonal T cell activation in vitro by inhibiting interleukin 2 production. J Exp Med 1998; 188: 287–96.PubMedGoogle Scholar
  74. 74.
    Read S, Mauze S, Asseman CF et al. CD38+CD45RB-low T cells: a population of T cells with immune regulatory activities in vitro. Eur J Immunol 1998; 28: 3435–47.PubMedGoogle Scholar
  75. 75.
    Read S, Powrie F. CD4(+) regulatory T cells. Curr Opin Immunol 2001; 13: 644.PubMedGoogle Scholar
  76. 76.
    Jutel M, Akdis M, Budak F, et al. IL-10 and TGF-β cooperate in the regulatory T cell response to mucosal allergens in normal immunity and specific immunotherapy. Eur J Immunol 2003; 33: 233–41.Google Scholar
  77. 77.
    Kammerer R, Chvatchko Y, Kettner A, Dufour N, Corradin G, Spertini F. Modulation of T-cell responses to phospholipase A2 and phospholipase A2-derived peptides by conventional Bee venom immunotherapy. J Allergy Clin Immunol 1997; 100: 96–103.PubMedGoogle Scholar
  78. 78.
    Bernstein DI, Mittman RJ, Kagen SL, et al. Clinical and immunologic studies of rapid immu-notherapy in Hymenoptera sensitive patients. J Allergy Clin Immunol 1989; 84: 951–9.PubMedGoogle Scholar
  79. 79.
    Eberlein-Konig B, Ullmann S, Thomas P, Przybilla B. Tryptase and histamine release due to a sting challenge in bee venom allergic patients treated successfully or unsuccessfully with hyposensitisation. Clin Exp Allergy 1995; 25: 704–12.Google Scholar
  80. 80.
    Stephan V, Kuhr J, Urbanek R. Relevance of basophil histamine release changes during venom immunotherapy. Allergy 1989; 44: 453–9.PubMedGoogle Scholar
  81. 81.
    Bonifazi F, Jutel M, Biló BM, et al. Prevention and treatment of hymenoptera venom allergy: guidelines for clinical practice. Allergy 2005; 60(12): 1459–70.PubMedGoogle Scholar
  82. 82.
    Ellis AK, Day JH. Clinical reactivity to insect stings. Curr Opin Allergy Clin Immunol 2005; 5: 349–54.PubMedGoogle Scholar
  83. 83.
    Mauriello PM, Barde SH, Georgitis JW, Reisman RE. Natural history of large local reactions from stinging insects. J Allergy Clin Immunol 1984; 74: 494–8.PubMedGoogle Scholar
  84. 84.
    Hepner M, Ownby D, Anderson J. Risk of severe reactions in patients taking beta blocker drugs receiving allergen immunotherapy injections. J Allergy Clin Immunol, 1990; 86: 407–411.PubMedGoogle Scholar
  85. 85.
    Toogood JH. Risk of anaphylaxis in patients receiving beta-blocker drugs. J Allergy Clin Immunol 1988; 81: 1–5.PubMedGoogle Scholar
  86. 86.
    Alam MM, Alvarez del Real G, Hsieh FH. Cardiopulmonary resuscitation (CPR) in patients with acute anaphylaxis taking beta-blockers. J Allergy Clin Immunol 2005; 115 (Suppl 2): Abs 160.Google Scholar
  87. 87.
    Simon P, Potier J, Thebaud HE. Risk factors for acute hypersensitivity reactions in hemodi-alysis. Nephrologie 1996; 17: 163–70.PubMedGoogle Scholar
  88. 88.
    Hermann K, Ring J. The rennin-angiotensin in patients with repeated anaphylactic reactions during Hymenoptera venom hyposensitization and sting challenge. Int Arch Allergy Immunol 1997; 112: 251–6.PubMedGoogle Scholar
  89. 89.
    White KM, England RW. Safety of angiotensin-converting enzyme inhibitors while receiving venom immunotherapy. Ann Allergy Asthma Immunol. 2008; 101(4): 426–30.PubMedGoogle Scholar
  90. 90.
    Schwartz HJ, Golden DBK, Lockey RF. Venom immunotherapy in the Hymenoptera-allergic pregnant patient. J Allergy Clin Immunol 1990; 85: 709–12.PubMedGoogle Scholar
  91. 91.
    Müller U, Mosbech H. Position paper. Immunotherapy with Hymenoptera venoms. EAACI. Allergy 1993; 48: 36–46.Google Scholar
  92. 92.
    Bucher C, Korner P, Wüthrich B. Allergy to bumblebee venom. Curr Opin Allergy Immunol 2001; 1: 361–5.Google Scholar
  93. 93.
    Stern A, Mullner RG, Wüthrich B. Successful treatment of occupational allergy to bumblebee venom after failure with honeybee venom extract. Allergy 2000; 55: 88–91PubMedGoogle Scholar
  94. 94.
    Biló BM, Rueff F, Mosbech H, Bonifazi F, Oude-Elberink JNG, EAACI Interest Group on Insect Venom Hypersensitivity. Diagnosis of Hymenoptera venom allergy. Allergy 2005; 60: 1339–49.PubMedGoogle Scholar
  95. 95.
    Reisman RE, Müller UR, Wypych JI, Lazell MI. Studies of coexisting honeybee and vespid-venom sensitivity. J Allergy Clin Immunol 1984; 73: 246–52.PubMedGoogle Scholar
  96. 96.
    Straumann F, Bucher C, Wüthrich B. Double sensitization to honeybee and wasp venom: immu-notherapy with one venom or with both venoms? Int Arch Immunol 2000; 123: 268–74.Google Scholar
  97. 97.
    Lichtenstein LM, Valentine MD, Sobotka AK. A case for venom treatment in anaphylactic sensitivity to Hymenoptera sting. N Engl J Med 1974; 290: 1223–7.PubMedGoogle Scholar
  98. 98.
    Golden DBK, Valentine MD, Kagey-Sobotka A, Lichtenstein LM. Regimens of Hymenoptera venom immunotherapy. Ann Intern Med 1980; 92: 620–4.PubMedGoogle Scholar
  99. 99.
    Yunginger JW, Paull BR, Jones RT, Santrach PJ. Rush venom immunotherapy program for honeybee sting sensitivity. J Allergy Clin Immunol 1979; 63: 340–7.PubMedGoogle Scholar
  100. 100.
    Laurent J, Smiejan JM, Bloch-Morot E, Herman D. Safety of Hymenoptera venom rush immunotherapy. Allergy 1997; 52: 94–6.PubMedGoogle Scholar
  101. 101.
    Bernstein AJ, Kagen SI, Bernstein DI. Rapid venom immunotherapy is safe routine in the treatment of patients with Hymenoptera anaphylaxis. Ann Allergy 1994; 73: 423–42.PubMedGoogle Scholar
  102. 102.
    Birnbaum J, Charpin D, Vervloet D. Rapid Hymenoptera venom immunotherapy: comparative safety of three protocols. Clin Exp Allergy 1993; 23: 226–30.PubMedGoogle Scholar
  103. 103.
    Golden DBK. Practical considerations in venom immunotherapy. Allergy Asthma Proc 1997; 18: 79–80.PubMedGoogle Scholar
  104. 104.
    Golden D, Kagey-Sobotka A, Valentine M, Lichtenstein L. Dose dependence of Hymenoptera venom immunotherapy. J Allergy Clin Immunol 1981; 67: 370–4.PubMedGoogle Scholar
  105. 105.
    Rueff F, Wenderoth A, Przybilla B. Patients still reacting to a sting challenge while receiving conventional Hymenoptera venom immunotherapy are protected by increased venom doses. J Allergy Clin Immunol 2001; 108: 1027–32.PubMedGoogle Scholar
  106. 106.
    Bousquet J, Menardo JL, Michel FB. Systemic reactions during maintenance immuno-therapy in honeybee venom. Ann Allergy 1988; 61: 63–8.PubMedGoogle Scholar
  107. 107.
    Golden DBK, Kagey-Sobotka A, Valentine MD, Lichtenstein LM. Prolonged-maintenance interval in Hymenoptera venom immunotherapy. J Allergy Clin Immunol 1981; 67: 482–4.PubMedGoogle Scholar
  108. 108.
    Gadde J, Sobotka A, Valentine M, Lichtenstein L, Golden D. Intervals of six and eight weeks in maintenance venom immunotherapy. Ann Allergy 1985; 54: 348.Google Scholar
  109. 109.
    Confino-Cohen R, Goldberg A, Mekori YA. Deliberate bee sting challenge of patients receiving maintenance venom immunotherapy at a 3-months interval. J Allergy Clin Immunol 1993; 91: 189–94.Google Scholar
  110. 110.
    Kochuyt AM, Stevens EAM. Safety and efficacy of a 12-week maintenance interval in patients treated with Hymenoptera venom immunotherapy. Clin Exp Allergy 1994; 24: 35–41PubMedGoogle Scholar
  111. 111.
    Hunt KJ, Valentine MD, Sobotka AK, Benton AW, Amodio FJ, Lichtenstein LM. A controlled trial of immunotherapy in insect hypersensitivity. N Engl J Med 1978; 299: 157–61.PubMedGoogle Scholar
  112. 112.
    Müller U, Thurnheer U, Patrizzi R, Spiess J, Hoigne R. Immunotherapy in bee sting hyper-sensitivity. Bee venom versus wholebody extract. Allergy 1979; 34: 369–78.PubMedGoogle Scholar
  113. 113.
    Brown S, Wiese M, Blackman K, Heddle R. Ant venom immunotherapy: a double blind, placebo-controlled cross-over trial. Lancet 2003; 361: 1001–6.PubMedGoogle Scholar
  114. 114.
    Müller U, Helbling A, Berchtold E. Immunotherapy with honeybee venom and yellow jacket venom is different regarding efficacy and safety. J Allergy Clin Immunol 1992; 89: 529–35.PubMedGoogle Scholar
  115. 115.
    Mosbech H, Malling H, Biering I, Böwadt H, Sooborg M, Weeke B, Löwenstein H. Immunotherapy with yellow jacket venom. Allergy 1984; 39: 543–9.PubMedGoogle Scholar
  116. 116.
    Lockey RF, Turkeltaub PC, Olive ES, Hussard JM, Baird-Warren IA, Buckantz SC. The Hymenoptera venom study. III. Safety of venom immunotherapy. J Allergy Clin Immunol 1990; 86: 775–80.PubMedGoogle Scholar
  117. 117.
    Mosbech H, Müller U. Side-effects of insect venom immunotherapy: results from an EAACI multicenter study. Allergy 2000; 55: 1005–10.PubMedGoogle Scholar
  118. 118.
    Berchtold E, Maibach R, Müller U. Reduction of side effects from rush-immunotherapy with honey bee venom by pre-treatment with terfenadine. Clin Exp Allergy 1992; 22: 59–65.PubMedGoogle Scholar
  119. 119.
    Gillman SA, Cummins LH, Kozak PP, Hoffman DR. Venom immunotherapy: comparison of “rush” vs “conventional” schedules. Ann Allergy 1980; 45: 351–4.PubMedGoogle Scholar
  120. 120.
    Brehler R, Wolf H, Kutting B, Schnitker J, Luger T. Safety of a two-day ultrarush insect venom immunotherapy protocol in comparison with protocols of longer duration and involving a larger number of injections. J Allergy Clin Immunol 2000; 105: 1231–5.PubMedGoogle Scholar
  121. 121.
    Brockow K, Kiehn M, Riethu” C, Vieluf D, Berger J, Ring J. Efficacy of antihistamine pretreatment in the prevention of adverse reactions to Hymenoptera immunotherapy: a prospective, randomized placebo-controlled trial. J Allergy Clin Immunol 1997; 100: 458–63.PubMedGoogle Scholar
  122. 122.
    Müller U, Hari Y, Berchtold E. Premedication with antihistamines may enhance efficacy of specific-allergen immunotherapy. J Allergy Clin Immunol 2001; 107: 81–86.PubMedGoogle Scholar
  123. 123.
    Reimers RE, Hari Y, Müller U. Reduction of side-effects from ultrarush immunotherapy with honeybee venom by pretreatment with fexofenadine: a double-blind, placebo-controlled trial. Allergy 2000; 55: 484–8.PubMedGoogle Scholar
  124. 124.
    Przybilla B, Ring J, Galosi A, Geursen RG, Stickl HA. Bee venom immunoglobulin for prophylaxis of anaphylactic reactions during bee venom immunotherapy (rush hyposensiti-zation). Immunol Allergy Pract 1986; 8: 107–11.Google Scholar
  125. 125.
    Jarisch R. Passive immunotherapy in bee venom allergic patients. Arch Dermatol Res 1981; 270: 230–5.Google Scholar
  126. 126.
    Quercia O, Rafanelli S, Puccinelli P, Stefanini GF. The safety of cluster immunotherapy with aluminium hydroxide-absorbed honeybee venom extract. J Investig Allergol Clin Immunol 2001; 11: 27–33.PubMedGoogle Scholar
  127. 127.
    Wyss M, Scheitlin T, Stadler BM, Wüthrich B. Immunotherapy with aluminium hydroxide absorbed insect venom extracts (Alutard SQ): immunologic and clinical results of a prospective study over 3 years. Allergy 1993; 48: 81–86.PubMedGoogle Scholar
  128. 128.
    Müller U, Rabson A, Bischof M, Lomnitzer R, Dreborg S, Lanner A. A double-blind study comparing monomethoxy polyethylene glycol modified honeybee venom and unmodified honeybee venom for immunotherapy. I. Clinical results. J Allergy Clin Immunol 1987; 80: 252–61.PubMedGoogle Scholar
  129. 129.
    Müller UR. Recombinant Hymenoptera venom allergens. Allergy 2002; 57: 570–6.PubMedGoogle Scholar
  130. 130.
    Birnbaum J, Ramadour M, Magnan A, Vervloet D. Hymenoptera ultra-rush venom immuno-therapy (210 min): a safety study and risk factors. Clin Exp Allergy 2003; 33: 58–64.PubMedGoogle Scholar
  131. 131.
    Fricker M, Helbling A, Schwartz L, Müller U. Hymenoptera sting anaphylaxis and urticaria pigmentosa: clinical findings and results of venom immunotherapy in ten patients. J Allergy Clin Immunol 1997; 100: 11–15.PubMedGoogle Scholar
  132. 132.
    Haeberli G, Bronnimann M, Hunziker T, Müller U. Elevated basal serum tryptase and Hymenoptera venom allergy: relation to severity of sting reactions and to safety and efficacy of venom immunotherapy. Clin Exp Allergy 2003; 33: 1216–20.PubMedGoogle Scholar
  133. 133.
    Oude Elberink JNG, De Monchy JGR, Kors JW, Van Doormaal JJ, Dubois AEJ. Fatal anaphylaxis after a yellow jacket sting, despite venom immunotherapy, in two patients with mastocytosis. J Allergy Clin Immunol 1997; 99: 153–4.PubMedGoogle Scholar
  134. 134.
    Rueff F, Wenderoth A, Przybilla B. Patients still reacting to a sting challenge while receiving conventional Hymenoptera venom immunotherapy are protected by increased venom doses. J Allergy Clin Immunol 2001; 108: 1027–32.PubMedGoogle Scholar
  135. 135.
    Oude Elberink JN, Dubois AE. Quality of life in insect venom allergic patients. Curr Opin Allergy Clin Immunol 2003; 3: 287–93.PubMedGoogle Scholar

Copyright information

© Springer 2009

Authors and Affiliations

  • Anne K. Ellis
    • 1
  • James H. Day
    • 2
  1. 1.Assistant Professor, Division of Allergy and Immunology, Department of Medicine and Department of Microbiology and ImmunologyQueen's University KingstonCanada
  2. 2.Professor and Head, Division of Allergy and Immunology, Department of MedicineQueen's UniversityKingstonCanada

Personalised recommendations