Outcomes of allergy to insect stings in children, with and without venom immunotherapy.
BACKGROUND
Children are thought to "outgrow" the allergy to insect stings, but there are no reports documenting the natural history of this reaction. We studied the outcome of allergic reactions to insect stings in childhood 10 to 20 years afterward in patients who had not received venom immunotherapy and in those who had been treated.


METHODS
Between 1978 and 1985, we diagnosed allergic reaction to insect stings in 1033 children, of whom 356 received venom immunotherapy. We conducted a survey of these patients by telephone and mail between January 1997 and January 2000, to determine the outcome of stings that occurred in the period from 1987 through 1999.


RESULTS
Of the 1033 patients, 512 patients (50 percent) responded, with a mean follow-up period of 18 years, a mean duration of venom immunotherapy of 3.5 years in treated patients, and an incidence of stings of 43 percent. Systemic reactions occurred less frequently in patients who had received venom immunotherapy (2 of 64 patients, or 3 percent) than in untreated patients (19 of 111 patients, or 17 percent; P=0.007). Patients with a history of moderate-to-severe reactions had a higher rate of reaction if they had not been treated (7 of 22 patients, or 32 percent) than if they had received venom immunotherapy (2 of 43 patients, or 5 percent; P=0.007). In patients who had been treated and who had a history of mild (cutaneous) systemic reaction (i.e., one with only cutaneous manifestations), none of the 21 subjects who received stings had a systemic reaction.


CONCLUSIONS
A clinically important number of children do not outgrow allergic reactions to insect stings. Venom immunotherapy in children leads to a significantly lower risk of systemic reaction to stings even 10 to 20 years after treatment is stopped, and this prolonged benefit is greater than the benefit seen in adults.
Johns Hopkins Asthma and Allergy Center, Baltimore, MD 21224, USA. dgolden1@jhmi.edu
David B K
DB
Golden
Anne
A
Kagey-Sobotka
Philip S
PS
Norman
Robert G
RG
Hamilton
Lawrence M
LM
Lichtenstein
D000818:Animals; D001514:Bee Venoms / Q000009:adverse effects / Q000276:immunology*; D002648:Child; D003625:Data Collection; D003888:Desensitization, Immunologic; D005500:Follow-Up Studies; D006801:Humans; D006927:Hymenoptera; D006969:Hypersensitivity, Immediate / Q000145:classification / Q000517:prevention & control; D015994:Incidence; D007299:Insect Bites and Stings / Q000276:immunology*; D012008:Recurrence; D012720:Severity of Illness Index
D001514:Bee Venoms