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Summary This study attempts to determine if atopy predisposes to, or affects the severity of, bee sting allergy. 119 consecutive patients with definite systemic reactions to Hymenoptera stings and 119 matched controls without a history of Hymenoptera allergy were interviewed and evaluated. These patients with a definite systemic reaction to Hymenoptera had a mean age of 27 years with an age range of 2‐73 years; 38% (forty‐five out of 119) were 12 years of age or younger. The frequency of atopy (asthma/allergic rhinitis) was 25% (thirty out of 119), and resembles that found in a general population. In the eighty‐nine patients (75%) without a personal history of atopy, only 8% had positive scratch tests to pollens, danders or molds, 44% had a positive family history of atopy and a majority had normal serum total IgE levels. Results of the RAST for specific IgE to venoms of honey bee, yellow jacket, hornet, wasp and to phospholipase A were obtained. Patients with asthma had a significantly more severe reaction to their Hymenoptera sting than non‐atopic patients, 65%vs 38%, with P <0.05. The severity of sting reaction in those patients with allergic rhinitis without asthma resembled that of the non‐atopic patients. Although atopy does not appear to predispose patients to Hymenoptera allergy, asthmatics’Who also have Hymenoptera allergy do have a significantly more severe reaction to a bee sting.

Summary We evaluated 587 cases with generalized reactions to stings of Hymenoptera. Eighty of these patients and twenty‐eight normal controls had radioallergosorbent tests (RAST) to venoms of honey bee, yellow jacket, hornet, wasp and to phospholipase A. Those patients with systemic reactions had a significantly greater frequency of positive RAST than normal controls (51.3%vs. 7.1%, P < 0.001). The frequency of atopy (asthma/rhinitis) in these 587 cases was only 22% and resembled the expected frequency in a general population. Asthmatic patients did not have an increased risk of developing systemic reactions to Hymenoptera stings. However, those asthmatic patients with systemic reactions to Hymenoptera stings had a significantly more severe anaphylactic reaction to a sting than non‐asthmatics. These severe reactions were primarily manifested by acute dyspnoea, which appeared to represent a bronchospastic response to endogenous histamine release.