Insect-Sting Anaphylaxis
Authors: Martin D. Valentine
Journal: Annals of Internal Medicine (1993)

Editorials1 February 1993Insect-Sting AnaphylaxisMartin D. Valentine, MDMartin D. Valentine, MDJohns Hopkins School of Medicine, Asthma and Allergy Center, Baltimore, MD 21224-6801.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-118-3-199302010-00013 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The European and American approaches to the diagnosis and treatment of insect-sting allergy differ, although there is consensus that venom immunotherapy is the treatment of choice for reducing the risk for future sting reactions. The role of challenge stings in selecting patients for prophylactic treatment is discussed.Death from allergic reactions to venoms from stinging insects (bees, hornets, yellowjackets, wasps, and fire ants) has been known since antiquity[1]. At least 40 fatalities from stings are reported each year in the United States. Those who are susceptible have been sensitized against specific venom antigens injected by a previous sting. Although not ...References1. Cohen SG. The pharaoh and the wasp. Allergy Proc. 1989; 10:149-51. Google Scholar2. Golden DB, Marsh DG, Kagey-Sobotka A, Freidhoff L, Szklo M, Valentine MD, et al. Epidemiology of insect venom sensitivity. JAMA. 1989; 262:240-4. Google Scholar3. Hunt KJ, Valentine MD, Sobotka AK, Benton AW, Amodio FJ, Lichtenstein LM. A controlled trial of immunotherapy in insect hypersensitivity. N Engl J Med. 1978; 299:157-61. Google Scholar4. Reisman RE. Natural history of insect sting allergy: relationship of severity of symptoms of initial sting anaphylaxis to re-sting reactions. J Allergy Clin Immunol. 1992; 90:335-9. Google Scholar5. Dvorin DD, Georgitis JW, Reisman RE. Natural history of insect sting anaphylaxis: evaluation of untreated and incompletely treated patients. J Allergy Clin Immunol. 1984; 73:188. Google Scholar6. van der Linden PW, Struyvenberg A, Kraaijenhagen RJ, Hack CE, van der Zwan JK. Anaphylactic shock after insect-sting challenge in 138 persons with a previous insect-sting reaction. Ann Intern Med. 1993; 118:161-168. Google Scholar7. Graft DF, Schuberth KC, Kagey-Sobotka A, Kwiterovich KA, Niv Y, Lichtenstein LM, et al. Assessment of prolonged venom immunotherapy in children. J Allergy Clin Immunol. 1987; 80:162-9. Google Scholar8. Reisman RE, Dvorin DJ, Randolph CC, Georgitis JW. Stinging insect allergy: natural history and modification with venom immunotherapy. J Allergy Clin Immunol. 1985; 75:735-40. Google Scholar9. Parker JL, Santrach PJ, Dahlberg MJ, Dahlberg MJ, Yunginger JW. Evaluation of Hymenoptera-sting sensitivity with deliberate sting challenges: inadequacy of present diagnostic methods. J Allergy Clin Immunol. 1982; 69:200-7. Google Scholar10. Valentine MD, Schuberth KC, Kagey-Sobotka A, Graft DF, Kwiterovich KA, Szklo M, et al. The value of immunotherapy with venom in children with allergy to insect stings. N Engl J Med. 1990; 323:1601-3. Google Scholar11. Levine MI. Systemic reactions to immunotherapy (Abstract). J Allergy Clin Immunol. 1979; 63:209. Google Scholar12. Smith PL, Kagey-Sobotka A, Bleecker ER, Traystman R, Kaplan AP, Gralnick H, et al. Physiologic manifestations of human anaphylaxis. J Clin Invest. 1980 Nov; 66:1072-80. Google Scholar13. Golden DB, Lawrence ID, Hamilton RH, Kagey-Sobotka A, Valentine MD, Lichtenstein LM. Clinical correlation of the venom-specific IgG antibody level during maintenance venom immunotherapy. J Allergy Clin Immunol. 1992; 90:386-93. Google Scholar14. Golden DB, Valentine MD. Allergen-specific IgG antibody measurements in the management of immediate hypersensitivity to Hymenoptera venoms. Journal of Clinical Immunoassay. 1983; 6:172-6. Google Scholar15. Golden DB, Addison BI, Blake K, Kagey-Sobotka A, Valentine MD, Lichenstenstein LM, et al. Discontinuing venom immunotherapy: Immunologic and clinical criteria. J Allergy Clin Immunol. 1987; 79:126. Google Scholar Author, Article, and Disclosure InformationAffiliations: Johns Hopkins School of Medicine, Asthma and Allergy Center, Baltimore, MD 21224-6801.Corresponding Author: Martin D. Valentine, MD, 2413 Ken Oak Road, Baltimore, MD 21209-4309. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAnaphylactic Shock after Insect-Sting Challenge in 138 Persons with a Previous Insect-Sting Reaction Peter-Willem G. van der Linden , Albert Struyvenberg , Rob J. Kraaijenhagen , C. Erik Hack , and J. Kees van der Zwan Metrics Cited byComposition des venins d’hyménoptères et de la salive des arthropodes hématophagesStinging insect hypersensitivityChallenge sting: to bee or not to beeStinging insect hypersensitivity: A practice parameter update 2011Venomous Animal InjuriesAllergie aux piqûres de moustiquesLife-threatening stings, bites, infestations, and parasitic diseasesPrevention of arthropod-related diseaseAnaphylaxis in the prehospital settingDiscontinuing venom immunotherapySTINGING INSECT HYPERSENSITIVITY: A PRACTICE PARAMETERRoutine analysis of plasma busulfan by gas chromatography–mass fragmentographyED management of insect stings 1 February 1993Volume 118, Issue 3Page: 225-226KeywordsAllergy and immunologyAllergy immunotherapyAnaphylaxisChildrenClinical trialsForecastingProspective studiesSafetyShockVenoms Issue Published: 1 February 1993 Copyright & PermissionsCopyright © 1993 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...