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Venom Allergy

Insect venom allergy can develop at any age: It may take several uneventful stings for manifestations to appear. After an initial sting, the immune system of an affected patient may respond by producing IgE antibodies. Any subsequent stings can trigger a systemic inflammatory response.1

It is important to correctly identify the culprit insect, as patients can be allergic to one or several species of stinging insects.1 It is also important to educate patients who work as beekeepers or greenhouse workers, or who participate in outdoor exercise, as their occupations and hobbies put them at increased risk for receiving a sting.1 Testing can be used to identify the insects to which a patient is sensitized, which will aid in the selection of the most appropriate treatment.2

Testing and Venom Immunotherapy

Venom immunotherapy (VIT) is the go-to treatment option for patients with a venom allergy. It has been shown to reduce the risk for future systemic reactions and the severity of a systemic reaction when one occurs.3 That is why guidelines recommended VIT as an option for the treatment of IgE-mediated bee and wasp venom allergy in patients who have had a:3

  • Severe systemic reaction to bee or wasp venom

OR

  • Moderate systemic reaction to bee or wasp venom and who also have additional risk factors, such as a high baseline serum tryptase, a high risk for future stings, or whose quality of life is significantly affected by venom allergy

VIT is most appropriate for patients with a sensitization to bee and wasp venom, as such, making a distinction between cross-reactivity and genuine double-sensitization is critical. 2,4-6 Up to 50% of venom-allergic patients have positive whole allergen test results to both bee and wasp venom extracts.6 Successful VIT is more likely when treatment selection is based on specific sensitization to bee and/or wasp venom.4

Learn about how adding components to your test menu can help resolve double positivity and match VIT to the individual patient.7

Testing for venom allergen sensitization >

Grading Symptoms of Venom Allergy

Venoms from the Hymenoptera order of insects—commonly known as bees, wasps, and some ants—may trigger systemic allergic reactions in some patients. These reactions, including anaphylaxis, can be severe and fatal even on the first exposure.1 Systemic reactions occur in approximately less than 1% of children, compared with around 3% of adults.4 Systemic reactions to a sting are most often IgE- mediated.1

Allergic reactions to bee or wasp venom can also be localized to the sting and can vary in severity.1 Patients experiencing a large local reaction will usually experience edema, erythema, and pruritus rapidly after the sting.1 These symptoms typically peak between 24 and 48 hours after the sting.1

 

References
  1. Pawankar R, Holgate S, Canonica G, at el. World Allergy Organization. White Book on Allergy (WAO). 2011. http://www.worldallergy.org/UserFiles/file/WAO-White-Book-on-Allergy_web.pdf. Accessed December 2017. 

  2. Biló B, Rueff F, Mosbech H, et al. Diagnosis of Hymenoptera venom allergy. Allergy. 2005; 60(11):1339-1349. 

  3. Cox L, Nelson H, Lockey R. Allergen immunotherapy: A practice parameter third update. J Allergy and Clin Immuno. 2011; 127(1):1-55

  4. Golden DBK. Insect Sting Anaphylaxis. Immunol Allergy Clin North Am. 2007 May;  27(2): 261–vii.

  5. Cox L, Larenas-Linnemann D, Lockey RF, et al. Speaking the same language: The World Allergy Organization Subcutaneous Immunotherapy Systemic Reaction Grading System. J Allergy Clin Immunol. 2010;125(3):569-74.