Hymenoptera venom allergies

Hymenoptera venom allergy affects a significant proportion of the population. More than half of the population will be stung by an insect at least once in their lifetime depending on the living environment and type of activity. ^1,2

Venom allergy is an IgE-mediated hypersensitivity reaction triggered by stings from insects such as bees, wasps, hornets, or other Hymenoptera species.

True simultaneous allergy to both bee and wasp venom is uncommon. In many cases, positive test results for both venoms reflect cross-reactivity rather than genuine dual sensitisation.

What are the symptoms?

In allergic individuals, symptoms typically appear within minutes of a sting.

Stings from bees, wasps, and hornets usually lead to brief pain and localised swelling. Sometimes, the swelling is more extensive (2.5–10 cm) and may last several days.

In certain cases, a rapid, whole-body reaction may occur, with symptoms such as³:

• Generalised itching (pruritus) or hives (urticaria), often affecting the face, chest, or extremities
• Facial or lip swelling (angioedema), especially around the eyes and mouth
• Flushing or redness of the skin
• Nasal congestion, sneezing, or runny nose
• Mild wheezing or coughing
• Nausea, vomiting, or abdominal cramping
• A sense of unease or dizziness, sometimes described as impending doom

Symptoms may initially be mild to moderate. However, reactions can escalate rapidly, particularly in adults and individuals at higher risk.

Why hymenoptera venom allergy can be serious?

Hymenoptera venom allergies represent the leading cause of anaphylaxis in adults^{4, 5}. These allergies affect a significant portion of the population, with sensitisation rates ranging between 9.3% and 28.7% among the general population, and more than half of all people will experience an insect sting at least once during their lifetime^1,2.

While most insect stings result in mild, localised reactions, individuals with venom allergies can experience life-threatening anaphylaxis from a single sting. In Europe, Hymenoptera venom allergy is responsible for 48.2% of adult anaphylaxis cases and 20.2% of cases in children⁵.

What is anaphylaxis?

Anaphylaxis is a rapid and severe allergic reaction which affects multiple organs simultaneously. When triggered by insect venom, symptoms include constricted airways, drops in blood pressure, rapid pulse, dizziness, loss of consciousness, and both gastrointestinal and neurological manifestations. In the most severe cases, it can be fatal^1,2.

Venom allergies are particularly unpredictable. Individuals who experience mild reactions to initial stings may suddenly develop life-threatening anaphylaxis after subsequent stings. The appropriate emergency response consists of administering adrenaline via intramuscular injection and promptly seeking medical assistance.

1.Bilò, M. B., Pravettoni, V., Bignardi, D., Bonadonna, P., Mauro, M., Novembre, E., ... & Pastorello, E. A. (2019). Hymenoptera venom allergy: management of children and adults in clinical practice. Journal of investigational allergology & clinical immunology, 29(3), 180-205.
2. Golden, D. B., Demain, J., Freeman, T., Graft, D., Tankersley, M., Tracy, J., ... & Wallace, D. (2017). Stinging insect hypersensitivity: a practice parameter update 2016. Annals of Allergy, Asthma & Immunology, 118(1), 28-5
3. Dongol et al., 2014
4. Stevens W. W., Kraft M., Eisenbarth S. C. Recent insights into the mechanisms of anaphylaxis. Curr Opin Immunol 2023;Apr.;81:102288. https://doi.org/10.1016/j.coi.2023.102288.
5. Worm, M., Moneret-Vautrin, A., Scherer, K., Lang, R., Fernandez-Rivas, M., Cardona, V., Kowalski, M. L., Bilò, M. B., Muraro, A., & Beyer, K. (2014). First European data from the network of severe allergic reactions (NORA). Allergy, 69(10), 1397-1404. https://doi.org/10.1111/all.12475