Chapter 4: Stinging insect allergy and venom immunotherapy.
The Hymenoptera order is divided into three families: Apids, Vespidae, and Formicidae. Apids include the honeybee, bumblebee, and sweat bee, which are all docile and tend to sting mostly on provocation. The Africanized killer bee, a product of interbreeding between the domestic and  African honeybee, is very aggressive and is found mostly in Mexico, Central America, Arizona, and California. The yellow jacket, yellow hornet, white (bald)-faced hornet, and paper wasp all belong to the Vespidae family. The Formicidae family includes the harvester ant and the fire ant. When  a "bee" sting results in a large local reaction, defined as >5 in. and lasting >24 hours, the likelihood of anaphylaxis from a future sting is ∼5%. For comparison, when there is a history of anaphylaxis from a previous Hymenoptera sting and the patient has positive skin  tests to venom, at least 60% of adults and 20-32% of children will develop anaphylaxis with a future sting. Both patient groups should be instructed about avoidance measures and carrying and knowing when to self-inject epinephrine, but immunotherapy (IT) with Hymenoptera venom is indicated  for those patients with a history of anaphylaxis from the index sting and not for patients who have experienced a large local reaction. IT is highly effective in that by 4 years of injections, the incidence of subsequent sting-induced anaphylactic reactions is 3%. This incidence may increase  modestly after discontinuation of injections but has not been reported >10% in follow-up.
Alan P
AP
Koterba
Paul A
PA
Greenberger
D000485:Allergens / Q000008:administration & dosage* / Q000276:immunology*; D001180:Arthropod Venoms / Q000008:administration & dosage* / Q000276:immunology*; D003888:Desensitization, Immunologic; D006801:Humans; D007299:Insect Bites and Stings / Q000145:classification / Q000175:diagnosis / Q000276:immunology* / Q000628:therapy*
D000485:Allergens; D001180:Arthropod Venoms