Diagnosis and management of hymenoptera venom allergy: British Society for Allergy and Clinical Immunology (BSACI) guidelines

Abstract

SummaryThis guidance for the management of patients with hymenoptera venom allergy has been prepared by the Standards of Care Committee (SOCC) of the British Society for Allergy and Clinical Immunology (BSACI). The guideline is based on evidence as well as on expert opinion and is for use by both adult physicians and pediatricians practising allergy. During the development of these guidelines, all BSACI members were included in the consultation process using a web-based system. Their comments and suggestions were carefully considered by the SOCC. Where evidence was lacking, consensus was reached by the experts on the committee. Included in this guideline are epidemiology, risk factors, clinical features, diagnostic tests, natural history of hymenoptera venom allergy and guidance on undertaking venom immunotherapy (VIT). There are also separate sections on children, elevated baseline tryptase and mastocytosis and mechanisms underlying VIT. Finally, we have made recommendations for potential areas of future research.

EAACI guidelines on allergen immunotherapy: Hymenoptera venom allergy

“…Generally, there is no evidence from the literature that VIT should be performed indefinitely in patients with mastocytosis. 48 However, VIT may be less protective in patients with severe initial SSR and mastocytosis and/or elevated serum tryptase (>11.4 lg/L). Therefore,…”

A Call for sting treatment protocol: Case report of a 3 year old with massive bee sting resulting in acute kidney injury

“…Bees, unlike wasps, leave stings behind which release large amounts of venom, 50-140 mcg/sting 1 leading to a spectrum of reactions from mild local allergic reactions to large local reactions and in some cases systemic toxic reaction. 1 Systemic toxic reactions, such as acute kidney injury, hepatic damage, neurological deficit, disseminated intravascular coagulopathy, hypotension, bronchoconstriction and even death, are seen in cases of massive bee envenomation. 1 The clinical presentation of this patient can be explained by the effect of the biochemical components of bee venom [2,3] The peptides and phospholipids contained in the venom actively cause destruction of red blood cells, release of histamine and other components by mast cells, causing pain and provoking haemolysis and rhabdomyolysis.…”

“…1 Systemic toxic reactions, such as acute kidney injury, hepatic damage, neurological deficit, disseminated intravascular coagulopathy, hypotension, bronchoconstriction and even death, are seen in cases of massive bee envenomation. 1 The clinical presentation of this patient can be explained by the effect of the biochemical components of bee venom [2,3] The peptides and phospholipids contained in the venom actively cause destruction of red blood cells, release of histamine and other components by mast cells, causing pain and provoking haemolysis and rhabdomyolysis. The sudden rise of our patient's serum creatinine suggesting rhabdomyolysis and fall in haemoglobin with haemoglobinuria can be explained by this mechanism of bee sting envenomation.…”

Guía de práctica clínica: Alergia a picadura de himenópteros en pediatría: actualización de 2017. Texto completo

“…6 Estudios epidemiológicos europeos comunican una prevalencia de reacciones sistémicas que varía desde 0,3% hasta 7,5%. En los niños, estas tasas son más bajas, desde 0,4% hasta 0,8%; 2,4 sin embargo, deben ser jerarquizadas, ya que las picaduras de himenópteros representan la tercera causa de anafilaxia en la infancia, luego de alimentos y fármacos.…”