Venom allergy

doi:10.1136/bmj.316.7141.1365

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Pamela W Ewan

Stings from bees and wasps, the most common stinging insects in Britain, can cause severe allergic reactions, including anaphylaxis. Coroners' data suggest that an average of four deaths from bee or wasp stings occur each year in the United Kingdom, but this is almost certainly an underestimate because venom anaphylaxis is not always recognised as the cause of death.

Honey bee (Apis mellifera): 1.5 cm long, fairly hairy and brown with abdominal bands

Hymenoptera insects

Classification

The hymenoptera are subdivided into families, including the Apidae (honey bees and bumble bees) and the Vespidae (wasps, hornets, and paper wasps). In Britain most reactions are caused by stings from wasps (the Vespula species) rather than from bees. Reactions to bee stings are almost always associated with the honey bee.

Venoms

Bee and wasp venoms are different, each containing distinct major allergens, which are well defined. Phospholipase A2 and mellitin occur only in bee venom, and antigen 5 only in wasp venom, but both venoms contain hyaluronidases. Patients allergic to wasp venom are rarely allergic to bee venom.

Wasp, also known as yellow jacket (Vespula spp): ≤1.5 cm long; yellow and black striped abdomen; typical waist; and little hair

Sensitisation

Most people, unless they have a specific occupational risk, are rarely stung by wasps, perhaps once every 10-15 years. Sensitisation to wasp venom requires only a few stings, and can occur after a single sting.

In contrast, allergy to bee venom occurs mainly in people who have been stung frequently by bees. Thus almost all patients who are allergic to bees are beekeepers or their families, or sometimes their neighbours.

Clinical features

The normal effect of a bee or wasp sting is to cause intense local pain, some immediate erythema, and often a small area (up to 1 cm diameter) of oedema. Allergic reactions can be either local or generalised. …