Unusual Reactions to Hymenoptera Stings: Current Knowledge and Unmet Needs in the Pediatric Population.

Riccardo Castagnoli,Lucia Liotti,Luca Pecoraro,Elio Novembre,Francesca Saretta,Gunter Johannes Sturm,Carla Mastrorilli,Lucia Caminiti,Mattia Giovannini,Francesca Mori,Stefania Arasi,Simona Barni,Gian Luigi Marseglia

doi:10.3389/fmed.2021.717290

Abstract

Hymenoptera stings are generally well-tolerated and usually cause limited local reactions, characterized by self-resolving erythema and edema associated with pain. However, Hymenoptera stings can induce immediate and delayed hypersensitivity reactions. In addition to these manifestations, unusual reactions to Hymenoptera stings have been reported. The latter are defined as unusual because of their atypical characteristics. They may differ from classical hypersensitivity reactions due to the stings' particular localization and the unusual involvement of one or more specific organs. Although unusual reactions to Hymenoptera stings are infrequent, it is essential for clinicians to know the possible related clinical manifestations. Here, we review the available literature and propose a diagnostic and management algorithm. At present, there are no defined guidelines for most of the unusual reactions to Hymenoptera stings, which should be managed in a tailored way according to the specifical clinical manifestations presented by the patients. Further studies are needed to better define these conditions and the underlying pathogenetic mechanisms to improve the diagnostic and therapeutic approach.

Highlights

Hymenoptera stings are generally well-tolerated and usually cause limited local reactions, characterized by self-resolving erythema and edema associated with pain
Hypotheses on the pathogenesis of this manifestation take into account immunological and non-immunological mechanisms; hypoxia and hypovolemia resulting from the systemic reaction to Hymenoptera sting may further promote the onset of cerebral stroke [11]
In particular in patients who have presented with potentially IgE-mediated systemic clinical manifestations consistent with mast cell/basophil mediator release, testing for Hymenoptera venom allergy (HVA) should be performed to assess whether the reaction may depend on an IgE-mediated allergic mechanism (Figure 1)

Summary

Introduction

Hymenoptera stings are generally well-tolerated and usually cause limited local reactions, characterized by self-resolving erythema and edema associated with pain. For the latter that include the toxic reactions after unusual massive stings, the clinical manifestations may be local or systemic, and the time of onset varies on case-by-case basis. Multi-organ involvement due to toxic reactions after unusual massive stings

Results

Conclusion