A longitudinal study of hymenoptera stings in preschool children.

Abstract

Insect venom is the second most common cause of anaphylaxis outside of medical encounters. Stings cause over 20% of all anaphylactic deaths and 7% of anaphylaxis in children. To date, there have been no longitudinal studies of insect sting events or allergy in preschool children. A prospective longitudinal nested observational study in the BASELINE Birth Cohort Study (n=2137). Sting-related questions were asked at 6 and 12months and 2 and 5years. Skin prick testing (SPT) was performed at 2 and 5years. SpIgE testing was performed on selected cases at 2years. Seventy-seven children (6.8%) were stung by the age of 2. Of these, 25 (32.5%) reported adverse reactions (four systemic). Eleven (0.9%) had positive SPT at 2years (eight bee, two wasp, one both). Four stung children had positive SPT. Two (one stung, one never stung) had positive spIgE to a venom component at 2years. A total of 268 children (21.9%) were stung by 5years, 144 (52.1%) reporting local reactions and none systemic. Four children (0.4%) had positive SPT at 5years: one bee and three wasp. Of the 11 SPT-positive children at 2years, none were still positive at 5years. This is the first longitudinal study of the natural history of hymenoptera stings and allergy in preschool children. Hymenoptera venom allergy is less common in this cohort than in adults. Systemic reactions were not medically documented in this population, in keeping with previous literature. This study confirms the poor correlation of IgE sensitization to venom with sting allergy and does not support the common parental request to screen children for sting allergy.