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Allergy to insect stings: long term outcomes

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Children get stung by insects and some of them (possibly around 1%) have a systemic allergic reaction. Venom immunotherapy (VIT) reduces the risk of subsequent systemic reactions but its disadvantages include cost, inconvenience, local and systemic reactions, and the need for prolonged treatment. Researchers in Baltimore, USA have previously concluded that VIT is not necessary for children who have had a mild (purely cutaneous) systemic reaction to an insect sting. They have now reported (

) on the long term follow up of children who did or did not receive VIT.

From a cohort of 1033 children who had a diagnosis of insect sting allergy made between 1978 and 1985, 512 responded to a survey between 1997 and 2002. Their mean age was 8 years at the time of their first reaction and 21 years at the time of the most recent reaction. Among children whose first systemic reaction was purely cutaneous, subsequent systemic reactions occurred after 12 of 89 stings (13%) among children not given VIT and after none of 21 stings among children given VIT (difference not statistically significant). Of the 12 subsequent systemic reactions in the no-VIT group six were mild and six moderate in intensity. After a first moderate-to-severe reaction the corresponding rates of systemic reaction were 7/22 (32%) without VIT and 2/43 (5%) with VIT—a significant difference. Six of the seven subsequent reactions in the no-VIT group were similar to the first reaction and one was less severe; none was severe. Two patients had received VIT after a first severe reaction and had moderate reactions after subsequent stings.

Most children outgrow the allergy to insect stings but some (about 13% of those not given VIT) still have a systemic allergic reaction when stung 20 years or more after the first reaction. The benefit of VIT seems to be long lasting, with significant protection 10–20 years after stopping the treatment (the mean duration of VIT among treated children in this study was 3.5 years).

Some children do not outgrow infant sting allergy. The authors of this paper recommend VIT for children who have had a moderate-to-severe systemic reaction (not purely cutaneous) after an insect sting.

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