Immunocap testing revealed class 3 to yellow hornet, paper wasp and honey bee as well as class 4 to yellow jacket.ġ) It seems unlikely that an IgE mediated reaction could occur after 1 week but could the history as represented here indicate a delayed IgE-mediated reaction or a T-cell mediated reaction manifesting as urticaria and angioedema?Ģ) Should immunotherapy be offered/recommended given this patient's outdoor occupation and risk for more severe reactions?ģ) Pt was rechallenged soon after above events and experienced no untoward effect. He developed a local reaction but nothing further. ~ 3 weeks after stopping the Prednisone, pt was stung again by what he thinks was a wasp (black). Symptoms eventually subsided with a 1 week course of Prednisone. 3 days later (1 week after the initial sting), he developed urticaria and angioedema of his lips, face and hands unresponsive to antihistamines. This continued for ~ 4 days then subsided. After he was stung he developed a local reaction that swelled mildly and became itchy and irritated. ![]() VIT could be consider for this clinical scenario but there is a paucity of data on this patient population.īelow is answer to a previous Ask the Expert question similar to yours: Ī 34 yo pool maintenance worker with no atopic history was seen after a bee sting in my office. Late-onset allergic reactions, including serum sick. Acute renal failure following multiple hornet stings. ![]() Sakhuja V, Bhalla A, Pereira BJG, Kapoor MM, Bhusnurmath SR, Chugh KS. Postscript to bee stings: delayed “serum sickness.” Hosp Pract 1983 18:36. The articles I could find were for the late 1980's and may provide some guidance for the treatment of your patient. There is not a lot of data on "delayed reactions" from sting reactions. There is evidence that VIT improves the quality of the patient’s life in patients with cutaneous systemic reactions." VIT is still an acceptable option if there are special circumstances, such as frequent exposure, or lifestyle considerations (potential impairment in quality of life) and must be weighed against added cost and potential inconvenience. Prospective sting challenge studies in adults found a less than 3% chance of a more severe reaction in such people. In a prospective field-sting study of children, there was a 10% chance of having a systemic reaction if re-stung (usually milder than their previous sting reactions), and a 3% or less chance of a more severe reaction. The decision to give VIT for patients with large local reactions must be weighed against the added cost and potential inconvenience." In patients with more local symptoms then "However, immunotherapy is usually not required for patients who have experienced only cutaneous systemic reactions after an insect sting. There is, however, increasing evidence that VIT significantly reduces the size and duration of large local reactions and thus might be useful in affected individuals with a history of frequent un- avoidable large local reactions and detectable venom specific IgE. "Most patients with large local reactions need only symptomatic care and are not candidates for testing for venom specific IgE or venom immunotherapy (VIT). ![]() The recent update on Stinging Insect Hypersensitivity addresses immediate dermal reactions to stings and suggests that large local reactions to a sting can be monitored clinically.
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