Abstract
The natural history of large local reactions to Hymenoptera stings allowed to estimate the risk to develop a systemic reaction after an initial large local reaction in about 4% of patients. A recently published study claimed that such risk concerns instead around one‐fourth of patients. However, such study is flawed by serious imprecision, particularly the unreliable identification by patients of the culprit insect, as well as the dubious identification of the causative venom in multisensitized patients. Also, the authors criticized previous studied because of the limited number of patients, while they included in the study 662 patients. Indeed, when only patients clearly restung by the same insect according to their history data were considered, the number of patients fell to 35. These data are unable to change the current shared concept on the low risk of systemic reactions in patients with initial large local reaction.
Highlights
The natural history of large local reactions to Hymenoptera stings allowed to estimate the risk to develop a systemic reaction after an initial large local reaction in about 4% of patients
Allergic reactions to Hymenoptera venom include systemic sting reactions (SSR), which when clinically expressed as anaphylaxis are burdened with mortality,[1,2] and large local reactions (LLR)
The study had as primary aim to evaluate the relevance of asymptomatic sensitizations to insect venom by sting challenges, but it was observed that 7.4% of 25 subjects with a previous LLR reacted systemically to the sting challenge and that 4.5%
Summary
Allergic reactions to Hymenoptera venom include systemic sting reactions (SSR), which when clinically expressed as anaphylaxis are burdened with mortality,[1,2] and large local reactions (LLR). Abstract The natural history of large local reactions to Hymenoptera stings allowed to estimate the risk to develop a systemic reaction after an initial large local reaction in about 4% of patients.
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