MMW Fortschr Med 2017 Sep;159(15):43-46

Pädiatrische Pneumologie und Allergologie, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital der LMU München, Lindwurmstr. 4, D-80337, München, Deutschland.

BMJ Case Rep 2017 Sep 7;2017. Epub 2017 Sep 7.

Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK.

A 45-year-old previously healthy man with minimal coronary artery disease on imaging presented with an acute MI after sustaining a wasp sting following previous non-eventful exposures throughout his life. This is the first case of Kounis syndrome with optical coherence tomography imaging and proven IgE wasp venom hypersensitivity. The Hymenoptera venom is composed of allergenic proteins and vasoactive amines which are responsible for venom toxicity. Read More

Allergol Immunopathol (Madr) 2017 Jul 21. Epub 2017 Jul 21.

Servicio de Alergología, Hospital Universitario de Guadalajara, Guadalajara, Spain.

Component-resolved diagnosis based on the use of well-defined, properly characterised and purified natural and recombinant allergens constitutes a new approach in the diagnosis of venom allergy. Prospective readers may benefit from an up-to-date review on the allergens. The best characterised venom is that of Apis mellifera, whose main allergens are phospholipase A2 (Api m1), hyaluronidase (Api m2) and melittin (Api m4). Read More

Wilderness Environ Med 2017 Sep 18;28(3):249-252. Epub 2017 Jul 18.

Departments of Nephrology (Dr Vikrant) and Community Medicine (Dr Parashar), Indira Gandhi Medical College, Shimla, India.

Acute kidney injury (AKI) is an unusual complication of wasp stings. Treatment of established AKI is largely supportive but the preventive strategies are not well documented. This is a report of 2 human cases that developed AKI after multiple wasp stings (Vespa magnifica). Read More

Allergol Int 2017 Jul 7. Epub 2017 Jul 7.

Department of Respiratory Medicine and Clinical Immunology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan.

Clin Mol Allergy 2017 15;15:13. Epub 2017 Jun 15.

Medicine and Surgery Department, University of Parma, via Gramsci n.14, 43126 Parma, Italy.

Allergen immunotherapy (AIT) is the only treatment that works on the causes of allergy. Available AIT nowadays are subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) for allergic rhinitis and asthma, while for allergy to Hymenoptera venom only subcutaneous route is recommended. A bulk of trials and meta-analyses demonstrated that efficacy and safety of AIT in decreasing allergic clinical symptoms and use of rescue medications, while its preventive capacity is yet under investigation. Read More

J Allergy Clin Immunol 2017 Jun 16. Epub 2017 Jun 16.

Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md.

Background: Clonal mast cell disorders are known to occur in a subset of patients with systemic reactions to Hymenoptera stings. This observation has prompted the question of whether clonal mast cell disorders also occur in patients with idiopathic anaphylaxis (IA).

Objective: We sought to determine the prevalence of clonal mast cell disorders among patients with IA, criteria to identify those patients who require a bone marrow biopsy, and whether the pathogenesis of IA involves a hyperresponsive mast cell compartment. Read More

Pediatr Emerg Care 2017 Jun 13. Epub 2017 Jun 13.

From the Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Objective: The purpose of this study was to evaluate the clinical characteristics of allergy to stings from the Hymenoptera order of insects in a hospital in Thailand.

Methods: A descriptive retrospective analytical study was carried out in inpatients and outpatients suffering from Hymenoptera stings from 2009 to 2013 in Siriraj Hospital.

Results: Medical records of 386 patients with an allergy to Hymenoptera stings were evaluated. Read More

Hum Vaccin Immunother 2017 Jun 12:1-15. Epub 2017 Jun 12.

a Center of Allergy and Environment (ZAUM), Technical University of Munich and Helmholtz Center Munich, Member of the German Center of Lung Research (DZL) , Munich , Germany.

Stings of hymenoptera can induce IgE-mediated hypersensitivity reactions in venom-allergic patients, ranging from local up to severe systemic reactions and even fatal anaphylaxis. Allergic patients' quality of life can be mainly improved by altering their immune response to tolerate the venoms by injecting increasing venom doses over years. This venom-specific immunotherapy is highly effective and well tolerated. Read More

Rev Inst Med Trop Sao Paulo 2017 Jun 1;59:e25. Epub 2017 Jun 1.

Universidade Federal do Ceará, Faculdade de Medicina, Departamento de Medicina Clínica, Fortaleza, Ceará, Brazil.

Bee stings can cause severe reactions and have caused many victims in the last years. Allergic reactions can be triggered by a single sting and the greater the number of stings, the worse the prognosis. The poisoning effects can be systemic and can eventually cause death. Read More

Postepy Dermatol Alergol 2017 Apr 13;34(2):159-167. Epub 2017 Apr 13.

Clinical Department of Internal Medicine, Asthma and Allergy, Medical University of Lodz, Lodz, Poland.

Introduction: Venom immunotherapy (VIT) is recommended as the first-line treatment for patients allergic to Hymenoptera venom.

Aim: To analyze the safety and efficacy of VIT in a real life setting.

Material And Methods: One hundred and eighty patients undergoing VIT were studied to evaluate the safety, efficacy, incidence and nature of symptoms after field stings and adverse reactions to VIT. Read More

J Allergy Clin Immunol Pract 2017 Sep - Oct;5(5):1264-1271. Epub 2017 May 10.

Department of Allergology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Background: Patients with indolent systemic mastocytosis (ISM) are at risk for severe anaphylactic reactions to yellow jacket (YJ) stings while demonstration of sensitization can be challenging because specific IgE (sIgE) levels are regularly below 0.35 kUA/L. The implication of missing YJ allergy is illustrated by a case of fatal anaphylaxis. Read More

Emerg Med Clin North Am 2017 May;35(2):355-375

Section of Emergency Medicine, University of Chicago, Chicago, IL, USA.

Arthropods (phylum Arthopoda) account for a higher percentage of morbidity and mortality to humans than do mammalian bites, snake bites, or marine envenomation. They are ubiquitous in domestic dwellings, caves, and campsites and in wilderness settings such as deserts, forests, and lakes. Although arthropods are most intrusive during warmer months, many are active throughout the winter, particularly indoors. Read More

J Investig Allergol Clin Immunol 2017;27(2):146-148

Department of Internal Medicine, Hospital and University of Santiago de Compostela, Santiago de Compostela, Spain.

J Investig Allergol Clin Immunol 2017;27(2):127-129

Department of Neurology, Wroclaw Medical University, Wroclaw, Poland.

Int Arch Allergy Immunol 2017 6;172(3):167-172. Epub 2017 Apr 6.

Division of Pediatric Pneumology and Allergy, University Hospital for Children and Adolescents, Leipzig, Germany.

Background: Data on the long-term outcome of children after specific venom immunotherapy (VIT) are limited. Therefore, we assessed sting recurrence and anaphylaxis relapse rates as well as adherence to anaphylaxis guidelines with regard to the availability of emergency equipment and education status.

Methods: For this long-term survey, data of 311 children with a history of anaphylactic reactions to hymenoptera stings were collected by chart review. Read More

Disaster Med Public Health Prep 2017 Mar 8:1-7. Epub 2017 Mar 8.

1Department of Surgery,Minamisoma Municipal General Hospital,Minamisoma,Fukushima,Japan.

Objective: Animals, including arthropods, are one health threat that can be affected by disasters. This institution-based study aimed to assess trends in Hymenoptera stings following the 2011 Fukushima nuclear disaster.

Methods: We reviewed the medical records of patients with hymenopteran stings who visited Minamisoma Municipal General Hospital, located 23 km from Fukushima Daiichi Nuclear Power Plant, from March 2005 to March 2016. Read More

Emerg Med Int 2017 6;2017:9162095. Epub 2017 Feb 6.

Department for Visceral Surgery and Medicine, Division of Acute Care Surgery, Bern University Hospital, Bern, Switzerland.

Introduction. Medical preparedness at mass gatherings is challenging, as little is known about the optimal planning. Most studies and case reports are based on mass casualty incidents, so the results cannot be extrapolated to mass gatherings. Read More

Can Vet J 2017 Mar;58(3):265-269

University of Florida College of Veterinary Medicine - Small Animal Clinical Sciences, Gainesville, Florida, USA (Buckley, Corrie, Schaer); Canada West Veterinary Specialists - Emergency & Critical Care, Vancouver, British Columbia (Bandt).

This report describes a case of honeybee envenomation in a dog that developed anaphylaxis after being stung by approximately 10 bees. The dog subsequently developed acute kidney injury. The dog had a previous mild increase in blood urea nitrogen with normal creatinine, possibly indicating an insidious chronic renal degenerative process that went into acute decompensation at the time of bee envenomation. Read More

Allergy Asthma Proc 2017 Mar;38(2):121-129

Background: Few data exist regarding the use of venom immunotherapy (VIT) in specific high-risk chronic medical conditions and pregnancy, and in young children.

Methods: A Web-based survey was sent to American Academy of Asthma Allergy & Immunology members to explore their VIT experience in potential high-risk medical conditions and pregnancy, and in young children. Major problems were defined as "activation of underlying disease and/or VIT not well tolerated (systemic adverse events) and/or VIT discontinued for medical reasons. Read More

J Investig Allergol Clin Immunol 2017;27(1):19-31

Hospital Universitario Clínico San Carlos, Madrid, Spain.

In this review, the Hymenoptera Allergy Committee of the SEAIC analyzes the most recent scientific literature addressing problems related to the diagnosis of hymenoptera allergy and to management of venom immunotherapy. Molecular diagnosis and molecular risk profiles are the key areas addressed. The appearance of new species of hymenoptera that are potentially allergenic in Spain and the associated diagnostic and therapeutic problems are also described. Read More

Pediatr Dermatol 2017 Mar 30;34(2):144-149. Epub 2017 Jan 30.

Department of Dermatology, Mayo Clinic Health System, Eau Claire, Wisconsin.

Background/objectives: Urticaria pigmentosa (UP) is the most common form of mastocytosis in children and is associated with systemic signs, symptoms, and triggers. To our knowledge, the effect of UP on children's quality of life has not been studied. The objective of the current study was to characterize the natural history, triggers, and complications of pediatric UP, identify prognostic indicators, and determine its effect on quality of life. Read More

Eur Ann Allergy Clin Immunol 2017 Jan;49(1):15-17

Allergy Unit, Loreto Crispi Hospital, ASL Napoli 1 - Centro, Naples, Italy. E-mail:

Background. Hymenoptera stings are sometimes fatal in venom-allergic patients. Fatalities mostly occur in previously stung subjects, especially those with a history of systemic reactions, and could be avoided if patients were properly informed of the existence of a prevention strategy for insect stings, referred to an allergy follow-up and prescribed auto-injectable epinephrine and/or venom-specific immunotherapy (VIT). Read More

Scand J Trauma Resusc Emerg Med 2017 Jan 14;25(1). Epub 2017 Jan 14.

Department of Dermatology and Allergy Center, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Sdr. Boulevard 29, Odense, DK-5000, Denmark.

Background: Bee and wasp stings are among the most common triggers of anaphylaxis in adults representing around 20% of fatal anaphylaxis from any cause. Data of pre-hospital treatment of bee and wasp induced anaphylactic reactions are sparse. This study aimed to estimate the incidence of bee and wasp induced anaphylactic reactions, the severity of the reactions and to correlate the pre-hospital treatment with the severity of the anaphylactic reaction. Read More

Ann Allergy Asthma Immunol 2017 Mar 7;118(3):366-367. Epub 2017 Jan 7.

Department of Allergy and Immunology, VA Greater Los Angeles Healthcare System, Los Angeles, California. Electronic address:

PLoS One 2017 3;12(1):e0168032. Epub 2017 Jan 3.

Department of Life Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

The escape behavior of a cockroach may not occur when it is either in a quiescent state or after being stung by the jewel wasp (Ampulex compressa). In the present paper, we show that quiescence is an innate lethargic state during which the cockroach is less responsive to external stimuli. The neuronal mechanism of such a state is poorly understood. Read More

Environ Entomol 2017 Feb;46(1):75-83

Division of Plant Sciences, University of Missouri, 1-31 Agriculture Bldg., Columbia, MO 65211

Natural enemies need not consume herbivores to suppress herbivore populations. Behavioral interactions can adversely impact herbivore fitness from reduced time feeding, investment in defense, or injury from failed attacks. The importance of such "nonconsumptive effects" for herbivore suppression may vary across species based on the specificity and intensity of the herbivore defensive response. Read More

Hautarzt 2017 Jan;68(1):67-75

Mastozytosezentrum der Klinik für Dermatologie, Venerologie, Allergologie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland.

Mastocytosis is a rare, almost exclusively sporadically occurring disease involving an increase in clonal tissue mast cells. The disease spectrum is heterogenous, ranging from isolated skin lesions with a normal life expectancy to rare, aggressive forms with very poor prognosis. Children are often affected. Read More

Ann Allergy Asthma Immunol 2017 Mar 13;118(3):326-332. Epub 2016 Dec 13.

Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Jaffe Food Allergy Institute, New York, New York.

Background: The direct comparison between children and adults with Hymenoptera venom anaphylaxis (HVA) has never been extensively reported. Severe HVA with IgE-documented mechanism is the recommendation for venom immunotherapy, regardless of age.

Objective: To determine the differences in the basic diagnostic profile between children and adults with severe HVA and its practical implications. Read More

Hum Vaccin Immunother 2017 Feb;13(2):477-483

a Department of Health Sciences , Postgraduate School in Occupational Medicine and Occupational Medicine Unit, IRCCS AOU San Martino-IST, University of Genoa , Genoa , Italy.

Objectives: To describe (i) the clinical characteristics of workers, exposed to hymenoptera stings, with an ascertained diagnosis of Hymenoptera Venom Allergy (HVA), (ii) the specific role of occupational exposure, (iii) the effect of Venom Immunotherapy (VIT) in reducing the severity of allergic episodes in workers exposed to repeated stings of hymenoptera, and (iv) the management of the occupational consequences caused by allergic reactions due to hymenoptera stings.

Methods: Between 2000 and 2013 an observational study, including patients referred to the regional reference hospital of Liguria, Italy, with an ascertained diagnosis of HVA and treated with VIT, was performed. A structured questionnaire was administered to all patients to investigate the occupational features of allergic reactions. Read More

J Exp Biol 2017 Feb 6;220(Pt 4):645-651. Epub 2016 Dec 6.

Division of Biological Sciences, Section of Ecology, Behavior and Evolution, University of California, San Diego, La Jolla, CA 92093, USA.

In colonial organisms, alarm pheromones can provide a key fitness advantage by enhancing colony defence and warning of danger. Learning which species use alarm pheromone and the key compounds involved therefore enhances our understanding of how this important signal has evolved. However, our knowledge of alarm pheromones is more limited in the social wasps and hornets compared with the social bees and ants. Read More

Immunol Allergy Clin North Am 2017 Feb 28;37(1):153-164. Epub 2016 Oct 28.

Department of Dermatology and Allergy Biederstein, Technische Universität München, Munich, Germany. Electronic address:

This article updates current knowledge on epidemiology, risk factors, triggers, and management of anaphylaxis in patients with mastocytosis. Hyperactive mast cells and higher number of effector mast cells are speculated to facilitate anaphylaxis in this condition. In children, increased risk is limited to those with extensive skin involvement and high tryptase. Read More

Am J Emerg Med 2017 Feb 4;35(2):360-362. Epub 2016 Nov 4.

Department of Anatomy, College of Medicine, Chungnam National University, Daejeon, Republic of Korea.

J Am Vet Med Assoc 2016 Nov;249(10):1138-1140

BMJ Case Rep 2016 Nov 1;2016. Epub 2016 Nov 1.

Department of Cardiology, Medical College Hospital, Trivandrum, Trivandrum, Kerala, India.

We report the case of a patient who, ∼3 weeks after multiple bee stings, developed a prolonged heart block, syncope and cardiac arrest. This required a temporary pacemaker to be implanted, which was later replaced with a permanent pacemaker. An ECG taken following surgery for a fractured humerus 6 years earlier was reportedly normal. Read More

Med Leg J 2016 Dec 26;84(4):212-214. Epub 2016 Jul 26.

Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Jodhpur, India.

Venomous insect stings are a cause of morbidity and mortality worldwide. The sting reactions are unpredictable and vary among individuals. A case of fatal insect sting in an elderly female is presented to discuss the associated challenges during necropsy. Read More

HNO 2016 Dec;64(12):927-942

Zentrum für Rhinologie und Allergologie, An den Quellen 10, 65183, Wiesbaden, Deutschland.

Due to the increasing incidence of hymenoptera venom allergies and the potentially life-threatening reactions, it is important for otolaryngologists working in allergology to have an understanding of modern diagnostic and treatment standards for this allergic disease. Molecular diagnosis with recombinant single allergens from bee and wasp venom components improves the diagnostics of insect venom allergies, particularly in patients with double-positive extract-based test results. Detection of specific sensitizations to bee or wasp venom enables double sensitizations to be better distinguished from cross-reactivity. Read More

Mil Med 2016 Oct;181(10):e1400-e1403

Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda MD 20889.

Hymenoptera venom allergy accounts for approximately 17% of all cases of anaphylaxis. Insect stings are a common occurrence across the world, with significant impact on active duty personnel. Venom immunotherapy (VIT) provides an effective treatment for those with systemic reactions to insect stings and other similar indications. Read More

Intern Med J 2017 Feb;47(2):170-176

Department of Epidemiology and Preventative Medicine, Monash Centre of Cardiovascular Research and Education in Therapeutics, Melbourne, Victoria, Australia.

Background: Accidental injury is a major public health problem in developed countries with 20 years elapsed since a national overview of venomous bites undertaken in Australia.

Aim: Provide the first contemporary epidemiological insight into venomous injuries based on demographics and geography nationally in Australia in the period 2000-2013.

Methods: An analysis of national hospitalisation and mortality data was undertaken to examine the incidence of injury and death due to envenoming in Australia. Read More

Bull Soc Pathol Exot 2016 Dec 13;109(5):325-328. Epub 2016 Oct 13.

Service de pédiatrie, hôpital national de Lamordé, université Abdou-Moumouni-Dioffo, Niamey, Niger.

We report a fatal case due to a massive attack by a swarm of bees in a nine-year-old child. The accident was fatal because of two aggravating factors: the cephalic location and the large number of stings (about 300). Complications were coagulopathy, anemia, hemorrhage, coma, and oligoanuria. Read More

Science 2016 09;353(6307):1499-1500

Centre for Behavioural Biology, School of Veterinary Science, University of Bristol, BS40 5DU, UK.

Int J Immunopathol Pharmacol 2016 Dec 27;29(4):726-728. Epub 2016 Sep 27.

Allergy and Clinical Immunology Unit- University of Messina, Italy.

US Army Med Dep J 2016 Oct-Dec(3-16):29-37

Navy and Marine Corps Public Health Center, Portsmouth, Virginia.

The article provides observations of multiple honey bee (Apis mellifera) swarms aboard the USNS Comfort (TAH-20) during the Continuing Promise 2015 mission. A brief overview of swarming biology is given along with control/removal recommendations to reduce sting exposures. The observations suggest that preventive medicine personnel should provide adequate risk communications about the potential occurrence of bee swarms aboard military ships, and medical department personnel should be prepared for the possibility of treating of multiple sting exposures, especially in the Southern Command Area of Operations where the Africanized genotype of A mellifera is common. Read More

J Emerg Med 2016 Oct 18;51(4):405-410. Epub 2016 Aug 18.

Department of Neurology, University Hospitals Case Medical Center, Cleveland, Ohio.

Background: Despite the common occurrence of hymenopteran stings worldwide, primary neurologic manifestations including stroke are rare. We report a case of a healthy male who developed a right middle cerebral artery (MCA) territory ischemic stroke after getting stung by a wasp.

Case Report: A 44-year-old man with hypertension presented to the hospital with sudden-onset left hemiparesis, left facial weakness, and dysarthria after being stung by a wasp. Read More

Allergol Int 2017 Jan 8;66(1):149-151. Epub 2016 Aug 8.

Department of Respiratory Medicine and Clinical Immunology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan.

Lakartidningen 2016 Aug 4;113. Epub 2016 Aug 4.

Futurum - Akademin för hälsa och vård - Länssjukhuset Ryhov Jönköping, Sweden Futurum - Akademin för hälsa och vård - Länssjukhuset Ryhov Jönköping, Sweden.

Bee and wasp stings can cause allergic reactions. Although the local reactions are more frequent, anaphylaxis due to insect stings can be potentially fatal. Rapid recognition of anaphylaxis is therefore critical and reactions should immediately be treated with i. Read More

Allergy 2017 Jan 26;72(1):98-108. Epub 2016 Aug 26.

Center of Allergy and Environment (ZAUM), Technical University of Munich and Helmholtz Center Munich, Munich, Germany.

Background: Hymenoptera stings can cause severe anaphylaxis in untreated venom-allergic patients. A correct diagnosis regarding the relevant species for immunotherapy is often hampered by clinically irrelevant cross-reactivity. In vespid venom allergy, cross-reactivity between venoms of different species can be a diagnostic challenge. Read More

Pediatr Emerg Care 2016 Aug;32(8):508-13

From the Departments of *Pediatrics Emergency Medicine †Pediatric Allergy and Immunology, and ‡Biostatistics, University of Arkansas for Medical Sciences and Arkansas Children Hospital, Little Rock, AR.

Objective: In 2006, the National Institute of Allergy and Infectious Disease established evidence-based treatment guidelines for anaphylaxis. The purpose of our study was to evaluate provider adherence to guidelines-based management for anaphylaxis in a tertiary care pediatric emergency department (ED).

Methods: Retrospective chart review was conducted of patients (0-18 years) presenting to the Arkansas Children Hospital ED from 2004 to 2011 for the treatment of anaphylaxis using International Classification of Diseases, Ninth Edition, codes. Read More

Int Arch Allergy Immunol 2016 22;170(2):97-100. Epub 2016 Jul 22.

Department of Allergology, Medical University of Gdansk, Gdansk, Poland.

Background: Allergen-specific immunotherapy is the most effective method of treatment in allergy to wasp venom. However, its mechanism of action is still not fully understood. The aim of this study is to describe changes in microRNA (miRNA) expression in patients undergoing the buildup phase of venom immunotherapy. Read More

Wilderness Environ Med 2016 Sep 15;27(3):405-8. Epub 2016 Jul 15.

Department of Emergency Medicine, SUNY Upstate Medical University, Syracuse, NY. Electronic address:

Bees and wasps of the Hymenoptera order are encountered on a daily basis throughout the world. Some encounters prove harmless, while others can have significant morbidity and mortality. Hymenoptera venom is thought to contain an enzyme that can cleave phospholipids and cause significant coagulation abnormalities. Read More