Bee Sting Research Articles

S1688 A Rare Case of Bee Sting Associated With Pancreatic Necrosis

S1688 A Rare Case of Bee Sting Associated With Pancreatic Necrosis

Subcutaneous Injection of Bee Venom in Wistar Rats: effects on blood cells and biochemical parameters.

ObjectivesBee venom (BV) therapy is performed by a bee sting or subcutaneous injection of BV. However, there is not much information on the effect of BV on blood parameters after entering the body. This project aimed to assess the side effects of subcutaneous BV injections in healthy rats by measuring the hematological and biochemical parameters.MethodsVarious amounts of BV, including 100, 200, and 500 (µg/day), were subcutaneously injected into rats for 30 days. The results showed that BV affected the metabolism of the liver, kidney, and glands.ResultsAn increase in blood sugar and a decrease in other biochemical parameters, including cholesterol, triglyceride, urea, creatinine AST, ALT, ALP, and phosphorous, were observed. Results also showed increased counts of white blood cells, neutrophils (%), and platelets and decreased levels of red cells, hemoglobin, and hematocrit.ConclusionThis study demonstrates that BV therapy in medical clinics requires routine care and testing to prevent eventual metabolic and anemia side effects.

Examining the Folk Medicine Elements Mentioned in Kemâleddîn Demîrî’s “Hayâtu’l-Hayevâni’l-Kübrâ” in Terms of Traditional Treatment Methods

Amaç: Meşhur Arap yazarı Kemâleddîn Demîrî, h.773/m.1372 yılında “Hayâtu’l-Hayevâni’l-Kübrâ” adlı bir zooloji kitabı hazırlamıştır. Yazar hayvanlarla ilgili bilgiler verirken söz konusu hayvanla ilgili ürünlerin hangi hastalıkların tedavisinde kullanılacağına dair bilgiler de vermiştir. Bu makale, “Hayâtu’l-Hayevâni’l-Kübrâ”da yer alan ve hastalıkların tedavisinde kullanılan hayvanları ve 14. yüzyılda Araplar arasındaki hastalık isimlerini ortaya koymayı amaçlamaktadır. Çalışmada, hayvanların kendilerinin veya çeşitli hayvansal ürünlerin hastalıklarda ne şekilde kullanılacağından söz edilecektir. Ayrıca eserde geçen halk hekimliği uygulamaları; gerçekçi yöntemler, büyü nitelikli yöntemler ve hem gerçekçi hem büyü nitelikli yöntemler doğrultusunda incelenecektir. Yöntem: Bu çalışma 03.12.2021 tarihleri ile 15.04.2022 tarihleri arasında hazırlanmış ve çalışmada Hayâtu’l-Hayevâni’l-Kübrâ’nın Beyrut baskısından ve 2018’de Rahmi Serin tarafından yapılan Türkçe tercümesinden yararlanılmıştır. Hastalıklarda kullanılan hayvan isimleri tespit edildikten sonra bu hayvanların hangi tür hastalıklarda ne şekilde kullanıldığı belirlenmiştir. Çalışmada hastalık isimleri alfabetik olarak sıralanmış ve bu hastalıkların hayvansal ürünlerle tedavisi verilmiştir. Bu doğrultuda “Hayâtu’l-Hayevâni’l-Kübrâ”da yer alan hastalıklar ve bunların hayvansal ürünlerle tedavisi, halk hekimliğinde kullanılan sağaltma yöntemleri doğrultusunda incelenmiştir. Bulgular: “Hayâtu’l-Hayevâni’l-Kübrâ”da elli altı adet hastalık ismi belirlenmiştir. Bu hastalıkların bir kısmı yılan, akrep ve arı sokması sonucunda oluşan zehirlenmeleri tedavi etmeye yöneliktir. Bunların dışında diş, baş, dalak ve göz ağrılarına ve çeşitli hastalıklara yer verilmiştir. Hastalıkların tedavisinde en fazla gerçekçi tedavi yöntemleri uygulanmış ve çoğunlukla hayvansal ürünlerden yararlanılmıştır. Sonuç: Geçmişten günümüze insanoğlu; ruhsal ve bedensel yaşadığı tüm rahatsızlıklarda, hayvansal ürünleri kullanarak rahatsızlıklarını gidermeyi arzulamıştır. Hastalıkların tedavisinde gerçekçi yöntemlerle birlikte büyü nitelikli yöntemlere de yer vermiştir. “Hayâtu’l-Hayevâni’l-Kübrâ”da da hayvansal ürünlerle yapılan tedavilerin yanı sıra hastalıkları tedavi etmek için çeşitli dualara ve efsunlara yer verilmiştir.

Adverse reactions in venom immunotherapy protocols: conventional versus ultra-rush

Background Venom immunotherapy (VIT) is an effective treatment in the patients at high risk of anaphylaxis or life-threatening systemic reactions due to Hymenoptera venom allergy. But, systemic and large local reactions can be observed, especially during the build-up phase of VIT. We evaluated the safety of conventional and ultra-rush build-up protocols. Materials and methods Two protocols in 71 patients (39 conventional and 32 ultra-rush protocols) with honeybee and wasp venom allergy were evaluated retrospectively. Patients were diagnosed and selected for VIT according to the criteria established by the European Academy of Allergy and Clinical Immunology. The severity of systemic reactions was evaluated according to the criteria of Mueller. Results Build-up phases were tolerated in 66.2% (n = 47) without any reaction. Allergic adverse reactions were observed in 33.8% (n = 24): large local reactions 22.5% (n = 16) and systemic reactions 11.3% (n = 8). There was no significant difference in the number of adverse reactions comparing patients receiving conventional and ultra-rush protocol. In addition, no association was found between allergic adverse reactions and the following factors: sex, previous systemic sting reactions, honeybee and wasp venom extract. Conclusion We found that both protocols were tolerated in patients with honeybee and wasp venom allergy. Ultra-rush protocol will be preferred for patients and clinicians because of its advantages in terms of time and costs. KEY MESSAGES VIT is the only curative treatment method that reduces the risk of severe reactions after a bee sting and improves the quality of life in patients with Hymenoptera venom allergy. Ultra-rush VIT protocol has advantages such as few injection and time savings. Both ultra-rush and conventional VIT are safe treatments to prevent potentially life-threatening reactions in patients with honeybee and wasp venom allergy.

Correlation between early changes of serum lipids and clinical severity in patients with wasp stings

Wasp stings are a serious problem worldwide, and patients in severe cases may experience multi-organ failure. However, the mechanism of hypolipidemia in patients with wasp stings is unknown. To investigate the relationship between early changes in lipid levels and clinical severity and the possible underlying mechanisms. A retrospective analysis of 212 patients (mild: 77; moderate: 50; severe: 85) with wasp stings was conducted. Clinical data, including lipid test results within 24 h of admission, were analysed. A total of 1060 healthy age- and gender-matched controls were used. Patients with wasp stings had lower lipid levels than healthy controls (P<0.01). Lipid levels decreased with disease severity, except for triglycerides (P<0.05). The number of stings, degree of organ failure, need for mechanical ventilation and extracorporeal blood purification, and mortality were higher in the severe group than in the mild and moderate groups (P<0.01). A decrease in lipid levels was accompanied by an increase in inflammatory indicators. In the severe group, a reduction in lipid levels was associated with ventilator application and blood purification, independent of survival status. Patients with wasp stings experience a reduction in lipid levels, which is related to the severity of clinical manifestations. Early lipid levels may serve as a simple indicator for the severity of wasp stings, and targeting lipid metabolism may be a novel treatment.

PENGARUH PELATIHAN INSECT BITE RESCUE TERHADAP PENANGANAN KORBAN CEDERA PADA SENGATAN TAWON DI DESA KENONGOSARI SOKO TUBAN

Early handling on sting emergencies due to wasp stings are must be handled quickly &amp; appropriatly things that need to be considered to avoid fatal condition. The treatment of bee sting emergencies is not yet known by many people and they only do modest treatment by applying cold compresses and leaving the wasp sting marks. The purpose of the study was to determine the effect of insect bite rescue training on the treatment of injured victims of wasp stings in the village Kenongosari Soko Tuban. This study uses a design Pre-Experimental, by one-group design pre-post test design. Simple random sampling used take a sample from 32 respondes. The instrument used are SOP and observation sheets. Data analysis using statistical testsWilcoxon. The results showed then was in scores of 29 respondents who experienced an increase. Analysis of research data using the Wilcoxon test. Wilcoxon test results obtained Asymp results. Sig. (2-tailed) = 0,000 with a significant value &lt;0.05, then H1 is accepted. So it can be concluded that the Insect Bite Rescue Training has an influence on the Behavior of Injuring Victims. And it is hoped that Insect Bite Rescue Training can be applied by for handling when exposed to wasp stings.

Adverse Events Associated with the Clinical Use of Bee Venom: A Review.

Bee venom is used to treat various diseases but can cause a tickling sensation and anaphylaxis during clinical treatment. Adverse events (AEs) associated with bee venom may vary depending on the dosage, method, route of administration, and the country, region, and user. We summarized the AEs of bee venom used in various ways, such as by the injection of extracts, venom immunotherapy (VIT), live bee stings, or external preparations. We conducted a search in eight databases up to 28 February 2022. It took one month to set the topic and about 2 weeks to set the search terms and the search formula. We conducted a search in advance on 21 February to see if there were omissions in the search terms and whether the search formula was correct. There were no restrictions on the language or bee venom method used and diseases treated. However, natural stings that were not used for treatment were excluded. A total of 105 studies were selected, of which 67, 26, 8, and 4 were on the injection of extracts, VIT, live bee stings, and external preparation, respectively. Sixty-three studies accurately described AEs, while 42 did not report AEs. Thirty-five randomized controlled trials (RCTs) were evaluated for the risk of bias, and most of the studies had low significance. A large-scale clinical RCT that evaluates results based on objective criteria is needed. Strict criteria are needed for the reporting of AEs associated with bee venom

Kounis Syndrome: A Novel Review

Kounis syndrome is characterised by a group of symptoms that manifests as unstable vasospastic or non-vasospastic angina secondary to a hypersensitivity reaction. It was first described by Kounis and Zavras in 1991 as the concurrence of an allergic response with an anaphylactic or anaphylactoid reaction and coronary artery spasm or even myocardial infarction. Since then, this condition has evolved to include a number of mast cell activation disorders associated with acute coronary syndrome. There are many triggering factors, including reactions to multiple medications, exposure to radiological contrast media, poison ivy, bee stings, shellfish, and coronary stents. In addition to coronary arterial involvement, Kounis syndrome comprises other arterial systems with similar physiologies, such as mesenteric and cerebral circulation resulting in ischemia / infraction of the vital organs. The Incidence of this condition is difficult to establish owing to the number of potential instigating factors and its relatively infrequent documentation in the literature. Anaphylaxis rarely manifests as a vasospastic acute coronary syndrome with or without the presence of underlying coronary artery disease. The variability in the underlying pathogenesis produces a wide clinical spectrum of this syndrome. Kounis syndrome is not just a single organ but also a complex multisystem and multiorgan arterial clinical conditions, it affects the coronary, mesenteric, and cerebral arteries and is accompanied by allergy hypersensitivity anaphylaxis involving Skin , respiratory system and vascular system in the context of anaesthesia, surgery, radiology ,oncology or even dental and psychiatric medicine , further it has significantly influences both morbidity and mortality. Kounis syndrome is caused by inflammatory mediators released during allergic insults, post inflammatory cell activation and interactions via multi directional stimuli. A platelet subset of 20% with high and low affinity IgE surface receptors is also involved in this process.

Value of procalcitonin as a potential biomarker in predicting acute kidney injury in patients with bee stings

To investigate the predictive value of procalcitonin (PCT) in the development of acute kidney injury (AKI) in patients after bee stings. A total of 105 bee stings patients admitted to Mianyang Central Hospital from May 2019 to August 2021 were enrolled and were divided into AKI group (37 cases) and non-AKI group (68 cases) according to the occurrence of AKI. Baseline demographic information [gender, age, body mass index (BMI), sting season, sting site, number of stings, underlying disease, clinical manifestations, and inflammatory factor levels] were collected and compared between the two groups. Logistic regression model was used to analyze the risk factors associated with the occurrence of AKI in bee stings patients. Pearson model was used to analyze the correlation between PCT and other indicators; the receiver operator characteristic curve (ROC curve) were drawn to analyze the predictive value of each indicator on the occurrence of AKI in bee stings patients. There were significant differences in age, number of bee stings, and vomiting after admission between the two groups of patients. The levels of serum creatinine (SCr), PCT, interleukin-6 (IL-6) and hypersensitive C-reactive protein (hs-CRP) were significantly higher in the AKI group than those in the non-AKI patients [SCr (μmol/L): 122.36±32.45 vs. 76.74±28.52, PCT (μg/L): 1.42±1.05 vs. 0.34±0.21, IL-6 (ng/L): 277.52±120.25 vs. 112.14±73.34, hs-CRP (mg/L): 7.64±3.26 vs. 3.01±2.13, all P < 0.05]. Serum PCT levels were positively correlated with serum SCr, IL-6, and hs-CRP levels in patients with AKI after bee stings (r values of 0.486, 0.393, and 0.425, respectively; P = 0.002, 0.016, and 0.009, respectively). Multivariate Logistic analysis showed that age, SCr, PCT, IL-6, and hs-CRP were independent risk factors for AKI in patients with bee stings. The ROC curve analysis showed that the area under the ROC curve (AUC) of age, SCr, PCT, IL-6 and hs-CRP for predicting AKI in patients with bee stings were 0.622 [95% confidence interval (95%CI) was 0.516 to 0.727], 0.722 (95%CI was 0.601 to 0.843), 0.869 (95%CI was 0.781 to 0.958), 0.739 (95%CI was 0.627 to 0.851) and 0.799 (95%CI was 0.700 to 0.900), respectively. The best cut-off value of PCT was 0.742 μg/L, the sensitivity was 75.70% and the specificity was 90.50%. The serum PCT level was significantly elevated in patients with AKI after bee stings, which is an independent risk factor for AKI after bee stings. Serum PCT level has better predictive efficacy for AKI after bee stings and can be used as a valid biomarker for clinical prediction.

Acute Parkinsonism and basal ganglia lesions after wasp sting.

Acute Parkinsonism and basal ganglia lesions after wasp sting.

Venomous spiders of Albania -does an increase of temperature influence the toxicity of spider venom?

Black widow spiders (Latrodectus sp.) are distributed worldwide, and in Albania the L. tredecimguttatus Rossi, 1790 has been the dominant spider. Other medically important spiders in Albania include the brown recluse with symptoms known as loxoscelism, the false black widow and the egg sac spiders; the last two inducing similar symptoms to a wasp sting. Methods: The data analyzed is from a decade-long study of 125 patients hospitalized in the regional hospital of Fier County, in the Western Lowland of Albania from May 2009 and to October 2018. Objective: Although the venom is rarely fatal, the recent spider bites raise questions about the influence of higher air temperatures on their possibly increased toxicity. Results: Significantly the severity of the α-latrotoxin rises during the summer, when human–spider contact frequency is higher and when the black widow spiders have an increased motivation to protect their egg sacs. Conclusion: This study revealed an increased severity of the black widow bites with respect to patient health, shown via all the severe systemic symptoms, during those months with higher temperatures.

Phenotypic and Transcriptomics Analyses Reveal Underlying Mechanisms in a Mouse Model of Corneal Bee Sting.

Corneal bee sting (CBS) is one of the most common ocular traumas and can lead to blindness. The ophthalmic manifestations are caused by direct mechanical effects of bee stings, toxic effects, and host immune responses to bee venom (BV); however, the underlying pathogenesis remains unclear. Clinically, topical steroids and antibiotics are routinely used to treat CBS patients but the specific drug targets are unknown; therefore, it is imperative to study the pathological characteristics, injury mechanisms, and therapeutic targets involved in CBS. In the present study, a CBS injury model was successfully established by injecting BV into the corneal stroma of healthy C57BL/6 mice. F-actin staining revealed corneal endothelial cell damage, decreased density, skeletal disorder, and thickened corneal stromal. The terminal-deoxynucleotidyl transferase mediated nick end labeling (TUNEL) assay showed apoptosis of both epithelial and endothelial cells. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis showed that cytokine–cytokine interactions were the most relevant pathway for pathogenesis. Protein–protein interaction (PPI) network analysis showed that IL-1, TNF, and IL-6 were the most relevant nodes. RNA-seq after the application of Tobradex® (0.3% tobramycin and 0.1% dexamethasone) eye ointment showed that Tobradex® not only downregulated relevant inflammatory factors but also reduced corneal pain as well as promoted nerve regeneration by repairing axons. Here, a stable and reliable model of CBS injury was successfully established for the first time, and the pathogenesis of CBS and the therapeutic targets of Tobradex® are discussed. These hub genes are expected to be biomarkers and therapeutic targets for the diagnosis and treatment of CBS.

Oral Calcinosis Circumscripta Associated with Wasp (Hymenoptera vespidae) Sting in a Cat

In veterinary medicine, calcinosis circumscripta is a morphological diagnosis for which the cause may be known or idiopathic. The aetiology of the lesion must be investigated because the nature of the underlying disease process will dictate appropriate treatment. We present a case of oral calcinosis circumscripta in a cat caused by a wasp sting and associated with moderate unilateral facial oedema. Following corticosteroid therapy and oedema resolution, hyperaemic, circular, firm, elevated lesions were observed on the buccal mucosa and evolved into whitish, slightly elevated multifocal plaques with an irregular surface. As antibiotic and corticosteroid therapy was ineffective, an excisional biopsy was performed after 6 months of lesion development and a diagnosis of calcinosis circumscripta of dystrophic aetiology was made. To our knowledge, this is the first report of calcinosis circumscripta in association with an insect sting in an animal. Insect stings should be included in the differential diagnosis of calcinosis circumscripta in cats.

Acute progressive large-area cerebral infarction caused by wasp sting: a case report

ABSTRACT Acute renal failure, multiple organ failure, and allergic reactions caused by wasp sting have been reported in many clinical reports, however, there are few reports on cerebral infarction due to wasp sting. We report a patient who developed acute progressive cerebral infarction after wasp stings, suffered from left-sided hemiplegia, clumsy speech, and left facial droop, only left the MRC grade 2 power and left conjugate gaze palsy after treatment. The MRA showed normal blood vessels. And the wasp sting was detected in head and right shoulder. We explored the mechanism by which the bee venom induced vasospasm and stimulated the superior cervical sympathetic ganglion leading to cerebral infarction. The treatment strategy is presented to provide experience for other clinicians.

Summer poisoning hazards

There is a seasonal risk with some poisons and in the summer, when stinging insects and adders are more active, there is a risk of envenomation. Diagnosis of an adder bite may be missed in horses, as the biting event is rarely witnessed. Envenomation may result in local swelling and occasionally, systemic effects. Multiple bee stings are particularly hazardous as this can result in multi-organ involvement, which may be fatal. Grazing on some plants, such as ragwort or bracken, for a prolonged period can also result in poisoning as ragwort contains pyrrolizidine alkaloids which cause liver failure and bracken contains an enzyme that has an anti-thiamine effect, inducing thiamine deficiency. Photosensitisation following exposure to plants containing phototoxins and bright sunlight is also a risk in summer. Treatment of plant poisoning in horses is generally supportive and involves removing the plant, providing good quality food and supportive care. Thiamine supplementation may be required in severe cases of bracken poisoning. Animals should be protected from sunlight following exposure to a phototoxin, with supportive management of skin lesions. Management of adder bite is supportive with administration of adder antivenom. Multiple bee stings require aggressive supportive care.

People’s Knowledge and Perceptions Towards Bee–Pollinators in the Southern Highlands, Tanzania: Conservation Implications and Strategies

Background and research aims Bees are important pollinators of flowering wild plants and agricultural crops that contribute significantly towards food security, improving people’s livelihoods, and maintaining genetic diversity in plant communities. However, the decline of the bee population due to anthropogenic changes and limited knowledge of bees is threatening bee diversity, particularly in sub–Saharan Africa. Negative perceptions, that is, fear and disgust, are common emotions that lead to a lack of support for bee conservation. Understanding local people’s perceptions is vital as it can help in bee conservation decision making and proper protection actions. Methods We conducted the study in the Mbeya and Songwe regions of Tanzania to assess the knowledge and perception of local people about bee–pollinators and conservation using a structured questionnaire Results We found that the majority of respondents (91%) have heard about bees (χ2 = 6275, p &lt; 0.001) and their conservation initiatives (71%), and about 84% of respondents consider bees to be important (χ2 = 168.9, p = 0.001). Moreover, Apis mellifera had the highest identification rate, with 52.7% of respondents. A binary logistic model revealed that respondents' knowledge of bee–pollinators and pollination is not influenced by their age (except for respondents aged 15–18 years, p = 0.012) and education level. While 74% of respondents claimed to be afraid of bees, 79% stated that bees are dangerous to humans. The most common cause is personal experience with bee stings. Poor farm management practices, for example, use of fire and deforestation, were noted by 79% of respondents as the most human activities threatening bee–pollinators. Conclusion Overall, the respondents were more familiar with A. mellifera compared to non–Apis bee species. Implications for conservation Thus, we suggest that implementation of pollinator management programs is vital to ensure their survival and reduce the perceived threat by dispelling myths and encouraging interest in bees.

Intracutaneous Skin Tests and Serum IgE Levels Cannot Predict the Grade of Anaphylaxis in Patients with Insect Venom Allergies.

BackgroundAllergies against Hymenoptera venoms are a major cause of severe anaphylaxis. Risk assessment for subjects with suspected allergy is difficult because there are currently no biomarkers that predict the likelihood of high-grade anaphylaxis other than several associated comorbidities.ObjectiveWe investigated the relationship between the severity of anaphylaxis and the results of intracutaneous skin tests (ICTs) together with serum levels of tryptase, total IgE, and venom-specific IgE, IgG, and IgG4.MethodsWe performed a retrospective evaluation of 194 patients who presented to a single medical center with allergies to bee venoms (Apis mellifera, Bombus spp.; n=24, 12.4%), vespid venoms (Vespula spp., Vespa spp., Polistes spp.; n=169, 87.1%), or both (n=1, 0.5%).ResultsIndex bee stings occurred earlier in the year than vespid stings, although the latter were reported more frequently overall. On average, subjects who previously experienced grade IV anaphylaxis required higher dosages of venom to yield positive ICTs than those who exhibited lower grade responses. Patients diagnosed with grade IV anaphylaxis exhibited significantly lower levels of venom-specific IgE and IgG and trended toward elevated levels of tryptase. No significant differences in average levels of venom-specific IgG4 and total IgE were observed.ConclusionOur findings reveal that intracutaneous skin testing and levels of venom-specific IgE do not predict the degree of anaphylaxis that develops in patients with venom allergy. Furthermore, the month of the index sting is not a reliable means to differentiate bee from vespid stings in patients presenting with an uncertain history.

Pediatric Penile Bee Sting.

The aims of this study, for the first time in the literature, are to evaluate the symptoms, clinical course, and treatment management of penile bee stings in children and to discuss whether bee stings can be evaluated within the scope of summer penile syndrome. Records of all pediatric patients presented to the emergency department of our hospital from June 2020 to October 2021 due to bee sting of penis were reviewed. Only patients with isolated penile bee stings were included in the study. Patients were evaluated in terms of the age at presentation, time of occurrence, symptoms, and treatment modality. There were 10 patients treated for penile bee sting. Patients ranged in age from 3 to 7 years (mean, 4.2 years). The most common complaints of the patients at presentation were pain (100%), swelling (100%), and dysuria (70%). Three of the patients were unable to void. The gauze moistened with warm saline was applied to the penis of these patients who developed glob, and all of these patients urinated after the warm application. Three of the patients had progressive erythema on the penile skin. These patients were admitted to the pediatric surgery department to monitor whether skin necrosis would develop. In all patients, the erythema regressed significantly within 48 hours and regained its completely normal appearance at the end of 72 hours. The probability of the development of serious local reactions and urological problems in penile bee stings is low. Oral nonsteroidal anti-inflammatory drug and warm, wet dressing are usually sufficient to treat local reactions. Penile bee stings may be evaluated within the scope of summer penile syndrome because their symptoms, clinical findings, and treatments are almost similar.

Ischemic Stroke Secondary to Bleach Anaphylaxis

Anaphylaxis is a severe allergic reaction characterized by life-threatening airway, breathing, and hemostatic problems. There has been an established association between cerebral infarction following wasp or bee sting in the literature. A 54-year-old female was admitted to the hospital for acute anaphylaxis due to bleach exposure and developed a new-onset left-sided weakness. Head computed tomography demonstrated midline frontal calcifications but was negative for acute ischemia or hemorrhage. Magnetic resonance imaging multifocal infarcts of the internal capsule’s right temporal and posterior limb. The patient was started on aspirin 81 mg, atorvastatin 40 mg daily for secondary prevention of stroke, and physical, occupational, and speech therapies. Although exceedingly rare, decreased cerebral blood flow may occur secondary to anaphylaxis due to an abrupt drop in blood pressure leading to ischemic injury. The case characterizes a unique association between bleach anaphylaxis and ischemic stroke, which has not been previously reported.

Honey bee venom re-challenge during specific immunotherapy: prolonged cardio-pulmonary resuscitation allowed survival in a case of near fatal anaphylaxis

BackgroundSpecific immunotherapy for patients with honey bee hypersensitivity is commonly applied. Re-challenge with venom is performed to prove protection in individual cases.Case presenationWe report a case of near fatal anaphylaxis with asystole for 24 min in a 35-years-old patient with mastocytosis after honey bee sting challenge, despite 5-years of specific immunotherapy. Successful cardio-pulmonary resuscitation was applied for 32 min.ConclusionThis intervention demonstrates, that in anaphylaxis with cardio-vascular arrest, prolonged cardio-pulmonary resuscitation for up to 40 min may be appropriate to overcome the half-life of massively released histamine. Failure of specific immunotherapy was possibly due to sensitization to the allergen Api m10, potentially underrepresented in commercial honey bee venom extracts. Molecular analyses may provide additional clues to the potentially unsuccessful outcome of venom specific immunotherapy, especially in high-risk patients such as mastocytosis.