Hymenoptera Venom Allergy in Children

Hymenoptera are taxonomically classified into different families: Apidae, including honeybees (Apis mellifera) and bumblebees (Bombus), Vespidae. The latter include subfamilies: Vespinae (wasps, including hornets, dolichovespules, and vespules) and Polistinae (paper wasp).Hymenoptera venom hypersensitivity can be associated with both nonimmunological and immunological (IgE- or non-IgE-mediated) mechanisms. Several types of reactions are possible: toxic, unusual local, large local, and systemic.An accurate clinical history and the correct use of skin and in vitro tests are crucial to properly diagnose Hymenoptera venom allergy. The in vitro tests comprise the dosage of specific serum IgE to venom extracts and to allergenic molecules. In complex diagnoses, Basophil Activation Tests and CAP inhibition can also be employed. Facing a systemic reaction, in order to exclude mastocytosis, a basal tryptase measurement should be carried out.Based on the current guidelines, in case of anaphylaxis during the acute phase of an allergic reaction to Hymenoptera stings, signs and symptoms shall be tackled with adrenaline as the first-line treatment as well as corticosteroids and antihistamines as subsequent lines of treatment.After a systemic reaction, the treatment for patients with hypersensitivity to Hymenoptera venom is based on venom immunotherapy (VIT), as there is no guarantee that subjects will not be stung again. In such cases, the venom is identified after a thorough allergological work-up. Both accelerated and conventional VIT administration protocols, performed in an adequate environment, have proved to be safe and effective.In patients with a previous episode of Hymenoptera venom anaphylaxis, preventing a second episode is essential. Early therapy and environmental protection measures must be enforced. It is important to avoid risky behaviors and insect-inhabited places.