George K. Boyd

Relationship of atopy and anaphylactic sensitization: a bee sting allergy model.

This study attempts to determine if atopy predisposes to, or affects the severity of, bee sting allergy. 119 consecutive patients with definite systemic reactions to Hymenoptera stings and 119 matched controls without a history of Hymenoptera allergy were interviewed and evaluated. These patients with a definite systemic reaction to Hymenoptera had a mean age of 27 years with an age range of 2‐73 years; 38% (forty‐five out of 119) were 12 years of age or younger. The frequency of atopy (asthma/allergic rhinitis) was 25% (thirty out of 119), and resembles that found in a general population. In the eighty‐nine patients (75%) without a personal history of atopy, only 8% had positive scratch tests to pollens, danders or molds, 44% had a positive family history of atopy and a majority had normal serum total IgE levels. Results of the RAST for specific IgE to venoms of honey bee, yellow jacket, hornet, wasp and to phospholipase A were obtained. Patients with asthma had a significantly more severe reaction to their Hymenoptera sting than non‐atopic patients, 65%vs 38%, with P <0.05. The severity of sting reaction in those patients with allergic rhinitis without asthma resembled that of the non‐atopic patients. Although atopy does not appear to predispose patients to Hymenoptera allergy, asthmatics’Who also have Hymenoptera allergy do have a significantly more severe reaction to a bee sting.

Prevalence of bee sting allergy in 2,010 girl scouts.

In a previous investigation from the clinic, the prevalence of Hymenoptera sting allergy was found to be 0.40 per cent in a population of 4,992 boy scouts (5) between the ages of II to 16 years. This past report represented one of the first epidemiologic studies done on bee sting allergy but is incomplete in that comparative figures are not available for females. The purpose of this study is to determine the prevalence of Hymenoptera sting allergy in females using a comparable study group exposed to similar environmental conditions.

Anaphylactic reactions to Hymenoptera stings in asthmatic patients.

We evaluated 587 cases with generalized reactions to stings of Hymenoptera. Eighty of these patients and twenty‐eight normal controls had radioallergosorbent tests (RAST) to venoms of honey bee, yellow jacket, hornet, wasp and to phospholipase A. Those patients with systemic reactions had a significantly greater frequency of positive RAST than normal controls (51.3%vs. 7.1%, P < 0.001). The frequency of atopy (asthma/rhinitis) in these 587 cases was only 22% and resembled the expected frequency in a general population. Asthmatic patients did not have an increased risk of developing systemic reactions to Hymenoptera stings. However, those asthmatic patients with systemic reactions to Hymenoptera stings had a significantly more severe anaphylactic reaction to a sting than non‐asthmatics. These severe reactions were primarily manifested by acute dyspnoea, which appeared to represent a bronchospastic response to endogenous histamine release.

Fatal nut anaphylaxis in a 16-year-old male: case report.

A case of fatal nut anaphylaxis in a 16-year-old atopic, steroid-dependent asthmatic male is reviewed. He had large positive skin tests (scratch) to walnuts and peanuts. Serum was positive for specific IgE antibody measured by solid-phase radioimmunoassay to pecans. The importance of the immediate use of epinephrine is emphasized. Accidental ingestion of foods to which patients are sensitive is a common error for which patients must be prepared with preloaded epinephrine syringes.

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)

Anaphylaxis from insect stings: Myths, controversy, and reality

Some myths and controversies regarding allergy to insect stings have been resolved through research, and venom immunotherapy now has an important place in the prevention of life-threatening reactions to stings. Both children and adults who had cardiovascular and/or respiratory reactions to their most recent sting are candidates for this treatment, which should be discontinued at the end of 5 years (or sooner, if venom skin tests or radioallergosorbent tests are negative).