Late-onset allergic reactions, including serum sickness, after insect stings.
Allergic reactions after insect stings may have a delayed onset, differing from the usual immediate anaphylactic pattern. Ten patients, aged 6 to 78 years, had allergic reactions 1 to 2 weeks after an insect sting. Six patients had had multiple stings preceding the reaction. In two instances, immediate anaphylaxis also occurred. Four of the 10 patients had serum sickness-type reactions; two other patients had more severe anaphylactic symptoms, including throat edema. All patients in this group had venom-specific IgE; four of the 10 patients had serum venom-specific IgG. Eight patients subsequently received venom immunotherapy (VIT). There have been no reactions from seven re-stings. Five patients had generalized hives starting 6 to 24 hours after an insect sting. All patients in this group had venom-specific IgE; three patients have received VIT. Two other patients developed hives, one with throat edema 3 days after an insect sting. Both patients had high titers of serum venom-specific IgE; neither patient has received VIT, one patient because of extreme sensitivity. These observations suggest that after an insect sting, patients may develop delayed-onset allergic symptoms that range from typical anaphylaxis to serum sickness and are mediated by venom-specific IgE. VIT is recommended for patients with these reactions.
Buffalo General Hospital, Department of Medicine, State University of New York 14203.
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Reisman
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Livingston
D000328:Adult; D000368:Aged; D000707:Anaphylaxis / Q000209:etiology; D000818:Animals; D001514:Bee Venoms / Q000008:administration & dosage / Q000276:immunology; D001516:Bees; D002648:Child; D005260:Female; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000209:etiology* / Q000276:immunology / Q000628:therapy; D007073:Immunoglobulin E / Q000096:biosynthesis / Q000276:immunology; D007074:Immunoglobulin G / Q000096:biosynthesis / Q000276:immunology; D007167:Immunotherapy; D007299:Insect Bites and Stings / Q000150:complications / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D011852:Radioallergosorbent Test; D012713:Serum Sickness / Q000209:etiology* / Q000276:immunology / Q000628:therapy; D012882:Skin Tests; D013997:Time Factors
D001514:Bee Venoms; D007074:Immunoglobulin G; D007073:Immunoglobulin E