Selections from Journal Watch Pediatrics and Adolescent medicine Copyright © 2004 Massachusetts medical Society. All rights reserved.

Bee stings in children: a 20-year follow-up study ▸

The natural history of bee sting allergy has important therapeutic and prognostic implications. Investigators in Baltimore followed 512 patients who had been diagnosed with insect sting allergy 10 to 20 years earlier (median age at diagnosis, 8 years). A total of 402 had systemic reactions; 163 of these patients received venom immunotherapy, and 239 did not. The remaining 110 children had large local reactions and did not receive therapy.

During follow-up, the following events occurred:

• In the local-reaction cohort, 44 patients were stung again, and 3 had systemic reactions, although none were severe (e.g., marked respiratory distress or hypotension).

• In the systemic-reaction cohort, 250 patients had initially experienced mild systemic reactions (involvement confined to the skin). Among those who did not receive immunotherapy, 13% who were stung again had systemic reactions (none severe). In contrast, among patients who did receive immunotherapy, none who were stung again had systemic reactions.

• In the systemic-reaction cohort, 152 patients had initially experienced moderate-to-severe systemic reactions; these patients had the highest risk for future systemic reactions. Among those who did not receive immunotherapy, 32% who were stung again had systemic reactions. In contrast, among those who did receive immunotherapy, only 5% who were stung again had systemic reactions.

Comment ▸

These data provide guidance on whom to refer for venom immunotherapy. Therapy is not necessary for children with large local reactions or mild systemic reactions but is warranted for children with moderate-to-severe systemic …