Ventricular fibrillation after a hymenoptera sting.

Area of Science:

• Cardiology
• Allergology
• Immunology

Background:

• Ventricular fibrillation (VF) is a life-threatening arrhythmia.
• Cardiac conditions often have identifiable causes like coronary disease or cardiomyopathy.
• Anaphylaxis is a severe allergic reaction that can manifest in various ways.

Observation:

• A 54-year-old male experienced two VF episodes post-defibrillation, with normal cardiac workup.
• Patient history revealed an Apis mellifera (honeybee) sting preceding VF episodes.
• Allergy testing showed positive IgE for A. mellifera venom, indicating a specific allergy.

Findings:

• The patient underwent immunotherapy (ITS) with A. mellifera extract, experiencing a controlled adverse reaction to the initial dose.
• The patient tolerated monthly maintenance doses for three years without adverse events.
• This case suggests A. mellifera venom allergy can trigger cardiac anaphylaxis, leading to VF in susceptible individuals.

Implications:

• Anaphylaxis, even without local symptoms, can be a trigger for unexplained ventricular arrhythmias.
• Allergy testing and immunotherapy can be safe and effective in managing cardiac anaphylaxis.
• This highlights the importance of considering allergic reactions in the differential diagnosis of unexplained cardiac events.