title: Insect venom hypersensitivity: experience in a clinical immunology/allergy service in Singapore.
abstract: BACKGROUND
  To study the profile of patients with allergy to the venom of insect stings.
  
  
  METHODS
  31 consecutive cases referred to our clinical immunology/allergy outpatient service from June 1, 1998 to June 30, 2002 were reviewed.
  
  
  RESULTS
  These patients comprised 3.5 percent of 889 cases referred during the study period. Their mean age was 28.8 +/- 10.5 (range 19-57) years and the majority were males (90.3 percent). Of these, 20 (64.5 percent) were Chinese, four (12.9 percent) were Malays and seven (22.6 percent) were of other races. 19 patients (61.3 percent) were men from the uniformed services including 12 (63.2 percent) full-time National Servicemen. 71 percent (22 patients) were stung for the first time. Urticaria (22 cases, 71.0 percent), dyspnoea (13, 41.9 percent), angioedema (12, 38.7 percent) and syncope (ten, 32.3 percent) were the most common manifestations of insect allergy. Anaphylaxis occurred in 22 (71.0 percent) cases, constituting 30.1 percent of all cases of anaphylaxis referred to our service during the study period. Although the causative insect was identified as honeybee (12, 38.7 percent), ant (four, 12.9 percent), wasp (three, 9.7 percent), and fire ant (two, 6.5 percent) by the majority of patients, ten (32.2 percent) patients were unable to identify the causative insect. The two patients stung by fire ants were Americans working in Singapore who had been stung while in the United States. Among those with anaphylaxis, honeybee, wasp and fire ant venom, for which specific immunotherapy is available, were identified as the cause in 40.9 percent, 4.5 percent, and 4.5 percent, respectively.
  
  
  CONCLUSIONS
  Insect venom hypersensitivity made up 3.5 percent of allergy/immunology referrals and 32.8 percent of cases of anaphylaxis referred to our institution. The majority were military servicemen who developed allergic reactions during the course of duty. The inability to identify the causative insect in 50 percent with sting anaphylaxis limits the role of specific immunotherapy in our patients.
authors.affiliation: Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433. bernard_thong@ttsh.com.sg
authors.forename: B Y H
authors.initials: BY
authors.lastname: Thong
authors.forename: K P
authors.initials: KP
authors.lastname: Leong
authors.forename: H H
authors.initials: HH
authors.lastname: Chng
mesh_terms: D000328:Adult; D000862:Ant Venoms / Q000276:immunology; D001180:Arthropod Venoms / Q000276:immunology*; D001514:Bee Venoms; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000453:epidemiology*; D007073:Immunoglobulin E; D007299:Insect Bites and Stings / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D011852:Radioallergosorbent Test; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012846:Singapore / Q000453:epidemiology
chemical_list: D000862:Ant Venoms; D001180:Arthropod Venoms; D001514:Bee Venoms; D007073:Immunoglobulin E