Avoidance of bee and wasp stings: an entomological perspective

Wings and stings: Hymenoptera on vacation

Traveling to different regions, one might encounter a species to which they have a known allergy, or other related and unrelated species. A first-time systemic reaction can occur while on vacation, even in those with previous asymptomatic stings. Three main groups of Hymenoptera are responsible for most sting reactions. Honey bee species are virtually identical around the world. Among social wasps (family Vespidae), the yellowjacket (genus Vespula and Dolichovespula) and hornet (genus Vespa) venoms have almost complete cross-reactivity, whereas paper wasp (genus Polistes) venoms show only partial cross-reactivity with other vespid venoms. Venom immunotherapy (VIT) confers 80% to 95% protection against related insects, though isolated species of paper wasps and yellowjackets exist in every country that may be distinct from the ones at home. Those allergic to imported fire ants (genus Solenopsis) in the United States should not react to other ant species around the world. Stinging ants belong to several unrelated subfamilies in different geographic regions, which do not have cross-reactive venom. The chances of encountering specific species of Hymenoptera at a traveler's destination vary by location, planned activities, and season. In this article, we discuss special considerations for traveling, including distribution of stinging insects around the world, risk factors for more severe reactions, ways to prepare for a trip, and when allergist examination or treatment may be helpful before travel.

Diversity and human perceptions of bees (Hymenoptera: Apoidea) in Southeast Asian megacities

Urbanization requires the conversion of natural land cover to cover with human-constructed elements and is considered a major threat to biodiversity. Bee populations, globally, are under threat; however, the effect of rapid urban expansion in Southeast Asia on bee diversity has not been investigated. Given the pressing issues of bee conservation and urbanization in Southeast Asia, coupled with complex factors surrounding human-bee coexistence, we investigated bee diversity and human perceptions of bees in four megacities. We sampled bees and conducted questionnaires at three different site types in each megacity: a botanical garden, central business district, and peripheral suburban areas. Overall, the mean species richness and abundance of bees were significantly higher in peripheral suburban areas than central business districts; however, there were no significant differences in the mean species richness and abundance between botanical gardens and peripheral suburban areas or botanical gardens and central business districts. Urban residents were unlikely to have seen bees but agreed that bees have a right to exist in their natural environment. Residents who did notice and interact with bees, even though being stung, were more likely to have positive opinions towards the presence of bees in cities.

The stinging Apidae and Vespidae (Hymenoptera: Apocrita) in Iranian islands, Qeshm, Abu-Musa, Great Tunb and Lesser Tunb on the Persian Gulf

OBJECTIVE

To study the stinging flying Hymenoptera (Apidae and Vespidae) fauna in four Iranian Islands, Qeshm, Greater Tunb, Lesser Tunb and Abu-Musa on the Persian Gulf.

METHODS

The flies were captured by used of Malaise trap, fly trap, bottle trap and insect net-hashing from March 2011 to July 2012.

RESULTS

In this study, 11 species of stinging Hymenoptera were reported for the first time in Persian Gulf region.

CONCLUSIONS

Some of this species such as Vespa orientalis and Polistes olivaceus are more common in the Persian Gulf islands and can cause clinical problem to islands resident and travelers.

Reactions to honeybee stings: an allergic prospective

PURPOSE OF REVIEW

The purpose of this article is to provide a brief overview of the events involved in honeybee allergy and to concisely update the reader on progress toward knowledge of honeybee venom (HBV), strides in solving diagnostic difficulties, and advancements in improving safety and efficacy of HBV immunotherapy.

RECENT FINDINGS

It is well known that honeybee allergy is unique in venom allergen and protein composition, diagnostic challenges, and immunotherapy safety and efficacy. Many new honeybee allergens have been recognized. Advances in testing, evaluation, and extract manipulation methods, many using recombinant technology, have allowed a greater ability to help with honeybee allergy diagnosis and resultant improvement in immunotherapy safety and evaluation of immunotherapy efficacy.

SUMMARY

In an effort to address many honeybee allergy concerns, specific advances have been recently made. Some recently characterized honeybee allergens appear to be major contributors to honeybee allergy. In the setting of double-positivity, cross-reacting carbohydrate determinants and other cross-reacting components in HBV have made diagnosis of honeybee allergy challenging. Recombinant technology, including component-resolved diagnostics, and other evolving testing methods should help clarify double-positivity, if not now, in the very near future. Purified HBV and possibly depot formulations for immunotherapy appear to make it more well tolerated. Recombinant methods may help with evaluation of immunotherapy's safety and efficacy.

Clinical features of children with venom allergy and risk factors for severe systemic reactions

BACKGROUND

Severe systemic reactions (SRs) to insect venom are rare in childhood and there are few data on this study population. The aim of our study is to analyze the clinical features and to document the risk factors for severe SRs in children with insect venom allergy.

METHODS

Children with SRs after Hymenoptera sting were analyzed. The diagnosis was based on medical history, skin tests and/or specific IgE testing.

RESULTS

Seventy-six children were included [57 boys (75%), mean age 9.8 ± 3.4 years]. The mean age of children at the time of SR was 8.3 ± 3.4 years. Reactions were accounted for Vespula (wasp) venom in 58 (76%) and Apis mellifera (bee) venom in 18 (24%) patients. Twenty-six percent of patients had aeroallergen sensitization and 33% had atopic disease, whereas 66% had experienced previous stings. The upper limb was the most frequent area of sting (43%), and the cutaneous system (99%) was the most frequent involved system. SRs occurred in 59% of patients. Multivariate logistic regression analysis revealed eosinophilia (>5%) [odds ratio (OR) 12.6; confidence interval (CI) 1.5-109.7; p = 0.022], female sex (OR 6.4; CI 1.5-26.9; p = 0.011) and accompanying atopic disease (OR 3.4; CI 1.2-12.3; p = 0.016) as significant risk factors for severe SRs. Ninety-seven percent of patients were admitted to the emergency department; however, epinephrine was used in only 46% of patients.

CONCLUSIONS

There was a high frequency of hypersensitivity to wasp venom among the study population, and severe reactions were related to mild eosinophilia, female sex and concomitant atopic diseases. A better understanding of the risk factors may lead to effective utilization of health care sources in the future.

The sting of the honeybee: an allergic perspective

OBJECTIVE

To provide a focused understanding of the uniqueness and special considerations of honeybee allergy.

DATA SOURCES

A PubMed search using the keywords honeybee, allergy, and hypersensitivity yielded the initial relevant articles. Additional significant sources cited in the reference lists of the initial articles were also used.

STUDY SELECTION

More than 130 articles were reviewed, and the most relevant references were selected for inclusion in this article.

RESULTS

The honeybee differs from other flying Hymenoptera from both an entomologic and allergic standpoint. The entomology literature is not often consulted by the allergist when addressing avoidance of honeybees. Beekeepers are a particular population at risk for honeybee exposure and allergy. Venom composition, sting mechanism, diagnostic evaluation, and immunotherapy efficacy and safety all have unique considerations specific to the honeybee.

CONCLUSIONS

Honeybee is a significant cause of venom hypersensitivity. By understanding unique behaviors of honeybees, proper avoidance measures may be addressed with patients. Honeybee venom is complex, and the delivery mechanism provides for a large but often variable amount of injected venom. Diagnosis of honeybee allergy by imperfect skin and serologic testing further complicated by cross-reactivity is often difficult. Generally, honeybee immunotherapy is less safe and less effective than for other flying Hymenoptera. Efforts to improve testing and immunotherapy are under way.

Prognosis of corneal wasp sting: case report and review of the literature

OBJECTIVES

To report the ocular complications associated with corneal wasp sting and to highlight the importance of eye protection in case of wasp offense.

METHODS

This was a retrospective, observational chart review.

RESULTS

A 34-year-old man was referred for severely decreased vision after being stung by a swap to the left cornea. Ophthalmologic examination showed a large corneal epithelial defect, anterior uveitis, and a left relative afferent pupillary defect. Vision was light perception. After treatment with cycloplegic, topical antibiotic, and systemic steroids for 2 weeks, the epithelial defect healed and anterior uveitis subsided; however, bulbous keratopathy and traumatic cataract developed. The visual acuity remained light perception with poor light projections. Twenty additional cases of corneal hymenoptera sting were reviewed from the English language literature, which shared certain characteristics including anterior uveitis, intractable glaucoma, traumatic cataract, toxic optic neuropathy, corneal scarring, and a catastrophic prognosis.

CONCLUSIONS

Wasp stings of the cornea may bring disastrous ocular damages. Outdoor works should manage to protect your eyes when confronted with a hymenoptera attack.

Anaphylaxis: past, present and future

Anaphylaxis is a clinical emergency, and recent reports suggest increased prevalence. A diverse set of primary genetic and environmental influences may confer susceptibility to anaphylactic reactions. Anaphylaxis presents diagnostic and therapeutic challenges. It often manifests with a broad array of symptoms and signs that might be similar to other diseases. The management of anaphylaxis consists of emergency treatment of acute episodes as well as preventive strategies to avoid recurrences. Treatment is complicated by its rapid onset and progression, presence of concurrent diseases or medications, and need for long-term allergen avoidance. Health care professionals must be able to recognize the signs of anaphylaxis, treat an episode promptly and appropriately, and provide preventive recommendations. Recognizing the gaps in our understanding and management of anaphylaxis may help identify promising targets for future treatment and prevention and areas that require further study.