[Insect sting allergy--clinical aspects, diagnosis and therapy]

Systemic allergic reactions following insect stings, most often by Hymenoptera (honey bee, wasp), are usually of the immediate type and thus mediated by venom specific IgE-antibodies. The most frequent clinical symptoms are: Urticaria, angioedema, asthma and anaphylactic shock. While up to 4% of individuals in epidemiological surveys give a history of systemic allergic reactions following Hymenoptera sings, fatal cases are extremely rare. Diagnosis is based on history, skin test and estimation of venom specific serum IgE-antibodies (RAST). For treatment of mild systemic reactions antihistamines are often sufficient. In all cases with respiratory and/or cardiovascular symptoms adrenalin must be given, either by inhalation or by injection. All patients with a history of systemic reactions of Hymenoptera stings have to be instructed in prophylactic measures and must receive emergency medications including adrenalin. The efficacy of venom immunotherapy is well documented, but this treatment is expensive: It is therefore mainly indicated in patients with a history of severe systemic reactions and a high degree of exposure.