Evaluation of the risk of anaphylactic reactions by wasp venom‐extract challenges in children

Abstract

Diagnostic sting challenges have been shown to provide information on the risk of further anaphylactic reactions to bee stings. We present a follow-up study in wasp venom-hypersensitive children after diagnostic venom extract challenges to analyze their risk of further anaphylactic reactions. Responses were obtained from 104 patients with wasp venom hypersensitivity out of 115 former patients. Only one of the 104 patients showed more than a severe local reaction to the sting challenge irrespective of the performance of a single or sequential challenge; therefore, only one patient received venom immunotherapy. The performance of a diagnostic sting challenge with wasp venom extract in children had a high negative predictive value of 94.6% for the risk of further systemic reactions. This was shown by analysis of later field stings, since 37 children experienced further field stings and only two of these children(5.4%) developed a mild systemic reaction (urticaria) equal to or less severe than the index sting. The value of the venom extract challenge can be interpreted in two ways: either it is less sensitive than a native sting challenge since the rate of systemic reactions to the challenge was very low, or the prognosis of wasp venom hypersensitivity in children is extremely favorable. Since the latter hypothesis is supported by the low incidence of systemic field sting reactions, we postulate that venom immunotherapy is necessary only in a minority of children with wasp venom hypersensitivity with an index sting reaction of Mueller grade I or II. However, the value of venom extract challenges as a general diagnostic instrument in children with Mueller I and II reactions due to wasp venom hypersensitivity may be questioned. It may have a place as a safe procedure in demonstrating to parents and physicians the often self-limiting natural course in most of these children.

Increased rate and greater severity of allergic reactions to insect sting among schoolchildren with atopic diseases

“…The current data on the association of atopic diseases to insect sting allergy are based mainly on studies from the1950s and 1970s (4–7). A recent investigation in children from Italy, reported a significant association between a positive skin test to venoms and a positive skin test to foods and aeroallergens, but no association with atopic diseases was observed (15).…”

“…Insect sting is one of the most common causes of anaphylaxis worldwide (1–3). Diagnostic sting challenges have been shown to provide information on the risk of further anaphylactic reaction (4, 5). There are limited and conflicting reports whether atopy is a risk factor for allergic reactions including anaphylaxis to insect stings.…”

Diagnosis of Hymenoptera venom allergy

“…As already evident from the fact that some patients tolerate VIT very well, but still have systemic reactions to a sting from the same insect, challenge tests with subcutaneously or intracutaneously administered venom are not reliable (82, 131). Therefore, if challenge tests are to be performed in Hymenoptera venom‐allergic patients these should be performed using live insects; the practical aspects are described extensively elsewhere (132).…”

Comparison of moderate to severe systemic reactions with honeybee and wasp in children

“…The relationship between the insect sting allergy and atopic conditions was addressed before the 2000s. Most of the early studies found no association between insect sting allergies and atopic conditions . Recently, 2 epidemiological surveys conducted in children in Israel and Ireland investigated this issue .…”