Natural history of insect sting allergy: the Rhode Island experience

The frequency of insect sting allergy in a given population varies depending on the age group of the population and the type of criteria used (history, skin test or RAST). In a pediatric population with a mean age of 13 years (boy scouts), the frequency is 0.8% using history as the only criteria. With this same criteria in an adult population, other authors found the frequency to be higher, 3.3%. The difference is probably due to the prolonged exposure rate to insect stings in adults. Using skin test or RAST as the criteria, the frequency of sting allergy is much higher because of many false-positive reactions. With history alone, the frequency of sting reaction is similar in atopic and nonatopic populations. Sting-sensitive asthmatic patients usually have a severe reaction to a sting with the added symptom of acute bronchospasm. Our RAST studies to venoms revealed that false-positive reactions do occur; a higher frequency of positive reactions occurs within five years of the sting and cross-reactivity among Hymenoptera insects is common except for honey bee. Negative RAST may have more clinical validity than a positive RAST. Our past and present re-sting data reveal that a large percentage of initially sting-sensitive patients have no reaction on being re-stung. Our new study on untreated sting-sensitive patients revealed that 37% (7/19) had an improved response and 42% (8/19) had the same response on re-sting.(ABSTRACT TRUNCATED AT 250 WORDS)