Follow-up of hymenoptera-sensitive patients without active immunotherapy

Presently there is no definitive guideline for the treatment of adult patients suffering from generalized insect sting reactions limited to skin manifestations or purely respiratory compromise who have not been treated with immunotherapy. Previous studies in adults demonstrate that the majority of patients with insect sting anaphylaxis have a decreased reactivity to re-sting with time, suggesting the insect allergy itself may be self-limiting. In this study, we evaluated 63 patients with initial insect sting manifestations limited to the skin and the respiratory system and noted the incidence and degree of natural re-sting reactions to these patients who had not undergone venom immunotherapy. In those patients with mild systemic reactions limited to the skin, none experienced an increase in severity. A local reaction was found on repeat sting in three of five patients in this group, and two of five had an equivalent cutaneous response (i.e., urticaria/angioedema). In five patients who had an initial respiratory reaction, four of the patients had a local reaction while one patient repeated the same respiratory manifestations. None of the patients with cutaneous or respiratory symptoms demonstrated a more severe reaction upon re-sting. This demonstrates that there is a natural progression of tolerance to insect stings in the adult population.