Bee stings in Brazil: Epidemiological aspects in humans.
Kono Isabelli Sayuri,Freire Roberta Lemos,Caldart Eloiza Teles,Rodrigues Fernando de Souza,Santos Julian Andrade,Freire Lucas Gabriel Dionisio,Faccin Tatiane Cargnin
Toxicon : official journal of the International Society on Toxinology
Bees are insects of the order Hymenoptera and are involved in human accidents. In Brazil, bees that cause accidents are crosses derived from Europeans with African bees and are known for their aggressive behavior. Despite being considered an important public health concern, epidemiological studies at the national level are scarce. The objective of this study was to verify the epidemiological profile of bee accidents in humans in Brazil, using data from 2009 to 2019 of the Brazilian Ministry of Health. It was found that bee accidents increased by 207.61% from the first to the last year of the present study. The incidence varied according to the geographical region; the southern region had more bee accidents, but the Northern region had more deaths caused by bee accidents. Besides, climatic conditions were associated with susceptibility to bee stings; the incidence was higher during spring and summer. Age was also associated with fatality rate, with the elderly being the group with the highest fatality rate. Our results demonstrate that accidents caused by bees involve factors related to patients, the environment, and the behavior of bees. It is important to know the epidemiological aspects to help prevent apidic accidents.
Deep Vein Thrombosis After a Wild Bee Sting.
Cil Metin,Leblebisatan Goksel,Leblebisatan Serife,Barutcu Adnan,Cil Merve K,Kilinc Yurdanur
Journal of pediatric hematology/oncology
Allergic reactions from insect bites are mostly observed with bee stings. Bee sting reactions can be classified into 3 main headings: local, systemic, and rare reactions. Vascular thrombosis is considered both in rare and systemic reactions. The wild bee venom induces the secretion of many inflammatory mediators, including histamine, phospholipase A1, and thromboxane, leading to vasoconstriction and thrombosis. Inflammatory cytokines also cause endothelial injury and deterioration of the microcirculation. In the literature, rare reactions have been reported including various central and arterial vascular pathologies such as aortic thrombosis, cerebral infarction, and myocardial infarction; however, there is rare publication concerning peripheral deep vein thrombosis (DVT). Although DVT produces good results with effective and rapid treatment, it can be fatal because of causes such as pulmonary embolism in the absence of timely intervention. Herein, for the first time in the literature, we present a pediatric case of peripheral DVT after a wild bee sting.
Bee sting leading to stroke: a case report and review of the literature.
Masaraddi Shivakumar K,Desai Rohan J,Deshpande Swanit Hemant,Patel Sameet
BMJ case reports
In India, bee stings are very common, seen mainly in farmers and honey collectors. Usually, it presents with local reactions and anaphylaxis. It rarely requires urgent hospitalisation. Other major complications seen are acute renal failure, intravascular coagulation, rhabdomyolysis and acute pulmonary oedema. Stroke as a presentation is uncommon. We report a case of a 45-year-old man presenting with right-sided hemiplegia and aphasia due to multiple bee stings. Diffusion MRI showed left middle cerebral artery territory hyperacute infarct.
Possible complication of bee stings and a review of the cardiac effects of bee stings.
Gupta Prabha Nini,Kumar B Krishna,Velappan Praveen,Sudheer M D
BMJ case reports
We report the case of a patient who, ∼3 weeks after multiple bee stings, developed a prolonged heart block, syncope and cardiac arrest. This required a temporary pacemaker to be implanted, which was later replaced with a permanent pacemaker. An ECG taken following surgery for a fractured humerus 6 years earlier was reportedly normal. The patient had been a rubber tapper who walked ∼1.5 km/day, but after the bee attack he was no longer able to walk or get up from the bed without experiencing syncope. We presume that the bee venom caused these signs, as well as the resulting heart block, which persisted long after the bee sting had subsided. Since his coronary angiogram was normal we believe he had a Kounis type involvement of the cardiovascular system, namely profound coronary spasm that caused complete heart block that did not recover. Another probable reason for the complete heart block could have been that the bees had consumed the pollen of a rhododendron flower, causing 'grayanotoxin' poisoning and severe heart block. The other effects of bee sting are discussed briefly.
Allergic angina following wasp sting: Kounis syndrome.
Anandan Prem Krishna,Hanumanthappa Natesh B,Bhatt Prabhavathi,Cholenahally Manjunath Nanjappa
Oxford medical case reports
Kounis syndrome is defined as an acute coronary syndrome triggered by the release of inflammatory mediators following an allergic insult characterized by acute onset of breathlessness, palpitations, diaphoresis and chest tightness (Gázquez V, Dalmau G, Gaig P, Gómez C, Navarro S, Mercé J. Kounis syndrome: report of 5 cases. J Investig Allergol Clin Immunol 2010;20:162-5). We report a 20-year-male patient who presented with acute myocardial infarction following a wasp sting at our institute. ECG showed non-ST-elevation myocardial infarction. Symptoms settled with hydrocortisone and adrenaline. Coronary angiogram revealed normal epicardial coronaries.
Anaphylactic cardiovascular collapse and Kounis syndrome: systemic vasodilation or coronary vasoconstriction?
Kounis Nicholas G,Cervellin Gianfranco,Koniari Ioanna,Bonfanti Laura,Dousdampanis Periklis,Charokopos Nikolaos,Assimakopoulos Stelios F,Kakkos Stavros K,Ntouvas Ioannis G,Soufras George D,Tsolakis Ioannis
Annals of translational medicine
The first reported human anaphylactic death is considered to be the Pharaoh Menes death, caused by a wasp sting. Currently, anaphylactic cardiovascular events represent one of most frequent medical emergencies. Rapid diagnosis, prompt and appropriate treatment can be life saving. The main concept beyond anaphylaxis lies to myocardial damage and ventricular dysfunction, thus resulting in cardiovascular collapse. Cardiac output depression due to coronary hypoperfusion from systemic vasodilation, leakage of plasma and volume loss due to increased vascular permeability, as well as reduced venous return, are regarded as the main causes of cardiovascular collapse. Clinical reports and experiments indicate that the human heart, in general, and the coronary arteries, in particular, could be the primary target of the released anaphylactic mediators. Coronary vasoconstriction and thrombosis induced by the released mediators namely histamine, chymase, tryptase, cathepsin D, leukotrienes, thromboxane and platelet activating factor (PAF) can result to further myocardial damage and anaphylaxis associated acute coronary syndrome, the so-called Kounis syndrome. Kounis syndrome with increase of cardiac troponin and other cardiac biomarkers, can progress to heart failure and cardiovascular collapse. In experimental anaphylaxis, cardiac reactions caused by the intracardiac histamine and release of other anaphylactic mediators are followed by secondary cardiovascular reactions, such as cardiac arrhythmias, atrioventricular block, acute myocardial ischemia, decrease in coronary blood flow and cardiac output, cerebral blood flow, left ventricular developed pressure (LVdp/dtmax) as well as increase in portal venous and coronary vascular resistance denoting vascular spasm. Clinically, some patients with anaphylactic myocardial infarction respond satisfactorily to appropriate interventional and medical therapy, while anti-allergic treatment with antihistamines, corticosteroids and fluid replacement might be ineffective. Therefore, differentiating the decrease of cardiac output due to myocardial tissue hypoperfusion from systemic vasodilation and leakage of plasma, from myocardial tissue due to coronary vasoconstriction and thrombosis might be challenging during anaphylactic cardiac collapse. Combined antiallergic, anti-ischemic and antithrombotic treatment seems currently beneficial. Simultaneous measurements of peripheral arterial resistance and coronary blood flow with newer diagnostic techniques including cardiac magnetic resonance imaging (MRI) and myocardial scintigraphy may help elucidating the pathophysiology of anaphylactic cardiovascular collapse, thus rendering treatment more rapid and effective.
A Multicenter Network Assessment of Three Inflammation Phenotypes in Pediatric Sepsis-Induced Multiple Organ Failure.
Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
OBJECTIVES:Ongoing adult sepsis clinical trials are assessing therapies that target three inflammation phenotypes including 1) immunoparalysis associated, 2) thrombotic microangiopathy driven thrombocytopenia associated, and 3) sequential liver failure associated multiple organ failure. These three phenotypes have not been assessed in the pediatric multicenter setting. We tested the hypothesis that these phenotypes are associated with increased macrophage activation syndrome and mortality in pediatric sepsis. DESIGN:Prospective severe sepsis cohort study comparing children with multiple organ failure and any of these phenotypes to children with multiple organ failure without these phenotypes and children with single organ failure. SETTING:Nine PICUs in the Eunice Kennedy Shriver National Institutes of Child Health and Human Development Collaborative Pediatric Critical Care Research Network. PATIENTS:Children with severe sepsis and indwelling arterial or central venous catheters. INTERVENTIONS:Clinical data collection and twice weekly blood sampling until PICU day 28 or discharge. MEASUREMENTS AND MAIN RESULTS:Of 401 severe sepsis cases enrolled, 112 (28%) developed single organ failure (0% macrophage activation syndrome 0/112; < 1% mortality 1/112), whereas 289 (72%) developed multiple organ failure (9% macrophage activation syndrome 24/289; 15% mortality 43/289). Overall mortality was higher in children with multiple organ and the phenotypes (24/101 vs 20/300; relative risk, 3.56; 95% CI, 2.06-6.17). Compared to the 188 multiple organ failure patients without these inflammation phenotypes, the 101 multiple organ failure patients with these phenotypes had both increased macrophage activation syndrome (19% vs 3%; relative risk, 7.07; 95% CI, 2.72-18.38) and mortality (24% vs 10%; relative risk, 2.35; 95% CI, 1.35-4.08). CONCLUSIONS:These three inflammation phenotypes were associated with increased macrophage activation syndrome and mortality in pediatric sepsis-induced multiple organ failure. This study provides an impetus and essential baseline data for planning multicenter clinical trials targeting these inflammation phenotypes in children.
A fatal case caused by massive honey bee stings.
Akyıldız Başak,Özsoylu Serkan,Öztürk Mehmet Adnan,İnci Abdullah,Düzlü Önder,Yıldırım Alparslan
The Turkish journal of pediatrics
Bee venom is a complex substance which acts in different ways; local or systemic anaphylaxis associated with IgE and direct toxic effects of the large volume of injected venom. We report a 10- year-old boy who was the vulnerable of 5989 honey bee attacks. To the best of our knowledge, this case had the ultimate number of honey bee stings in the literature, until now. He was admitted to pediatric intensive care unit after 3 hours of incident. Plasmapheresis was started to remove circulating venom that can cause many systemic side effects. Unfortunately, multiorgan failure developed on the 2nd day of admission due to severe hemolysis and rabdomyolysis. Additional therapies modalities, mechanical ventilation, hemodialysis, and antihypertensive drugs were added to the treatment during the disease process. Despite all of the treatments, the patient was failed on 12th day of hospitalization.
Lipid mediators in immune regulation and resolution.
Gilroy Derek W,Bishop-Bailey David
British journal of pharmacology
We are all too familiar with the events that follow a bee sting-heat, redness, swelling, and pain. These are Celsus' four cardinal signs of inflammation that are driven by very well-defined signals and hormones. In fact, targeting the factors that drive this onset phase is the basis upon which most current anti-inflammatory therapies were developed. We are also very well aware that within a few hours, these cardinal signs normally disappear. In other words, inflammation resolves. When it does not, inflammation persists, resulting in damaging chronic conditions. While inflammatory onset is actively driven, so also is its resolution-years of research have identified novel internal counter-regulatory signals that work together to switch off inflammation. Among these signals, lipids are potent signalling molecules that regulate an array of immune responses including vascular hyper reactivity and pain, as well as leukocyte trafficking and clearance, so-called resolution. Here, we collate bioactive lipid research to date and summarize the major pathways involved in their biosynthesis and their role in inflammation, as well as resolution. LINKED ARTICLES: This article is part of a themed section on Eicosanoids 35 years from the 1982 Nobel: where are we now? To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v176.8/issuetoc.
[Wasp and bee venom allergy].
Knulst A C,de Maat-Bleeker F,Bruijnzeel-Koomen C A
Nederlands tijdschrift voor geneeskunde
To diagnose insect venom allergy a good patient history is important. Allergological tests (skin test, specific IgE titre) confirm the diagnosis. Patients are advised on preventive measures (e.g. with respect to clothing and use of perfume). They are also instructed on medical treatment (antihistaminics, epinephrine) in case they are stung again. In patients having had a serious systemic reaction immunotherapy should be considered. Immunotherapy leads to complete protection in more than 98% of patients with wasp (yellow jacket) venom allergy and in 75-80% of patients with bee venom allergy. Serious adverse reactions to immunotherapy are rare. Immunotherapy lasts at least 3 to 5 years. After cessation of immunotherapy the frequency of systemic reactions to the sting of a wasp or bee is in the range of 5-15%. There are insufficient data on the long-term effect of immunotherapy.
Climate changes and Hymenoptera venom allergy: are there some connections?
Turillazzi Stefano,Turillazzi Francesco
Current opinion in allergy and clinical immunology
PURPOSE OF REVIEW:This review aims to update the world status of the main allergenic stinging Hymenoptera. RECENT FINDINGS:In this review, we consider the problems that social Hymenoptera (bees, wasps and ants) could represent in the nearest future for human health in different parts of the world. SUMMARY:Distribution and consistency of allergenic species including venomous insects are interested by accelerated dynamics caused by climate changes and globalization. Owing to the expansion of ranges of native species and colonization of invasive ones, even in the uncertainty of present available models, new challenges presented by stinging Hymenoptera should be expected in the future.
The Honeybee Venom Major Allergen Api m 10 (Icarapin) and Its Role in Diagnostics and Treatment of Hymenoptera Venom Allergy.
Jakob Thilo,Rauber Michèle Myriam,Perez-Riverol Amilcar,Spillner Edzard,Blank Simon
Current allergy and asthma reports
PURPOSE OF REVIEW:In Hymenoptera venom allergy, the research focus has moved from whole venoms to individual allergenic molecules. Api m 10 (icarapin) has been described as a major allergen of honeybee venom (HBV) with potentially high relevance for diagnostics and therapy of venom allergy. Here, we review recent studies on Api m 10 characteristics as well as its role in component-resolved diagnostics and potential implications for venom-specific immunotherapy (VIT). RECENT FINDINGS:Api m 10 is a major allergen of low abundance in HBV. It is an obviously unstable protein of unknown function that exhibits homologs in other insect species. Despite its low abundance in HBV, 35 to 72% of HBV-allergic patients show relevant sensitization to this allergen. Api m 10 is a marker allergen for HBV sensitization, which in many cases can help to identify primary sensitization to HBV and, hence, to discriminate between genuine sensitization and cross-reactivity. Moreover, Api m 10 might support personalized risk stratification in VIT, as dominant sensitization to Api m 10 has been identified as risk factor for treatment failure. This might be of particular importance since Api m 10 is strongly underrepresented in some therapeutic preparations commonly used for VIT. Although the role of Api m 10 in HBV allergy and tolerance induction during VIT is not fully understood, it certainly is a useful tool to unravel primary sensitization and individual sensitization profiles in component-resolved diagnostics (CRD). Moreover, a potential of Api m 10 to contribute to personalized treatment strategies in HBV allergy is emerging.
Poisoning by toxic animals in China--18 autopsy case studies and a comprehensive literature review.
Chen Long,Huang Guang-zhao
Forensic science international
Although exposure to animal venom and poison, such as snakebites, bee stings, and contact, with toads, is a common problem, reported deaths are rare. The present report discusses 18 fatal cases in China. Causes of death were grouped into 6 categories, including 1 case of tetrodotoxin poisoning, 1 case of gallbladder poisoning, 3 cases of snake venom toxicity, 4 cases of melittin toxicity, 4 cases of cantharidin poisoning and 5 cases of venenum bufonis poisoning. The epidemiology of each venom-induced death, the mechanism of exposure to venom, and the target organs and tissues affected by these toxic animals were here systematically reviewed. Such details are important to even suspected cases of venom damage. The associated problems related to forensic medicine, such as manner of death and possible attribution to the toxic effects of various animals, are also discussed herein.
Component Resolved Diagnosis in Hymenoptera Anaphylaxis.
Tomsitz D,Brockow K
Current allergy and asthma reports
PURPOSE OF REVIEW:Hymenoptera anaphylaxis is one of the leading causes of severe allergic reactions and can be fatal. Venom-specific immunotherapy (VIT) can prevent a life-threatening reaction; however, confirmation of an allergy to a Hymenoptera venom is a prerequisite before starting such a treatment. Component resolved diagnostics (CRD) have helped to better identify the responsible allergen. RECENT FINDINGS:Many new insect venom allergens have been identified within the last few years. Commercially available recombinant allergens offer new diagnostic tools for detecting sensitivity to insect venoms. Additional added sensitivity to nearly 95% was introduced by spiking yellow jacket venom (YJV) extract with Ves v 5. The further value of CRD for sensitivity in YJV and honey bee venom (HBV) allergy is more controversially discussed. Recombinant allergens devoid of cross-reactive carbohydrate determinants often help to identify the culprit venom in patients with double sensitivity to YJV and HBV. CRD identified a group of patients with predominant Api m 10 sensitization, which may be less well protected by VIT, as some treatment extracts are lacking this allergen. The diagnostic gap of previously undetected Hymenoptera allergy has been decreased via production of recombinant allergens. Knowledge of analogies in interspecies proteins and cross-reactive carbohydrate determinants is necessary to distinguish relevant from irrelevant sensitizations.
Insect venom phospholipases A1 and A2: Roles in the envenoming process and allergy.
Perez-Riverol Amilcar,Lasa Alexis Musacchio,Dos Santos-Pinto José Roberto Aparecido,Palma Mario Sergio
Insect biochemistry and molecular biology
Insect venom phospholipases have been identified in nearly all clinically relevant social Hymenoptera, including bees, wasps and ants. Among other biological roles, during the envenoming process these enzymes cause the disruption of cellular membranes and induce hypersensitive reactions, including life threatening anaphylaxis. While phospholipase A2 (PLA2) is a predominant component of bee venoms, phospholipase A1 (PLA1) is highly abundant in wasps and ants. The pronounced prevalence of IgE-mediated reactivity to these allergens in sensitized patients emphasizes their important role as major elicitors of Hymenoptera venom allergy (HVA). PLA1 and -A2 represent valuable marker allergens for differentiation of genuine sensitizations to bee and/or wasp venoms from cross-reactivity. Moreover, in massive attacks, insect venom phospholipases often cause several pathologies that can lead to fatalities. This review summarizes the available data related to structure, model of enzymatic activity and pathophysiological roles during envenoming process of insect venom phospholipases A1 and -A2.
Animal toxins and renal ion transport: Another dimension in tropical nephrology.
Sitprija Visith,Sitprija Siravit
Nephrology (Carlton, Vic.)
Renal vascular and tubular ion channels and transporters involved in toxin injury are reviewed. Vascular ion channels modulated by animal toxins, which result in haemodynamic alterations and changes in blood pressure, include ENaC/Degenerin/ASIC, ATP sensitive K channels (KATP ), Ca activated K channels (Kca) and voltage gated Ca channels, mostly L-type. Renal tubular Na channels and K channels are also targeted by animal toxins. NHE3 and ENaC are two important targets. NCC and NKCC may be involved indirectly by vasoactive mediators induced by inflammation. Most renal tubular K channels including voltage gated K channels (Kv1), KATP , ROMK1, BK and SK are blocked by scorpion toxins. Few are inhibited by bee, wasp and spider venoms. Due to small envenoming, incomplete block and several compensatory mechanisms in renal tubules, serum electrolyte charges are not apparent. Changes in serum electrolytes are observed in injury by large amount of venom when several channels or transporters are targeted. Envenomings by scorpions and bees are examples of toxins targeting multiple ion channels and transporters.
A systematic review of the clinical effectiveness and cost-effectiveness of Pharmalgen® for the treatment of bee and wasp venom allergy.
Hockenhull J,Elremeli M,Cherry M G,Mahon J,Lai M,Darroch J,Oyee J,Boland A,Dickson R,Dundar Y,Boyle R
Health technology assessment (Winchester, England)
BACKGROUND:Each year in the UK, there are between two and nine deaths from anaphylaxis caused by bee and wasp venom. Anaphylactic reactions can occur rapidly following a sting and can progress to a life-threatening condition within minutes. To avoid further reactions in people with a history of anaphylaxis to bee and wasp venom, the use of desensitisation, through a process known as venom immunotherapy (VIT), has been investigated and is in use in the UK. VIT consists of subcutaneous injections of increasing amounts of purified bee and/or wasp venom extract. Pharmalgen® products (ALK Abelló) have had UK marketing authorisation for VIT (as well as diagnosis) of allergy to bee venom (using Pharmalgen Bee Venom) and wasp venom (using Pharmalgen Wasp Venom) since March 1995. OBJECTIVE:This review assessed the clinical effectiveness and cost-effectiveness of Pharmalgen in providing immunotherapy to individuals with a history of type 1 [immunoglobulin E (IgE)-mediated] systemic allergic reaction to bee and wasp venom. DATA SOURCES:A comprehensive search strategy using a combination of index terms (e.g. Pharmalgen) and free-text words (e.g. allerg$) was developed and used to interrogate the following electronic databases: EMBASE, MEDLINE, The Cochrane Library. REVIEW METHODS:Papers were included if they studied venom immunotherapy using Pharmalgen (PhVIT) in patients who had previously experienced a systemic reaction to a bee and/or a wasp sting. Comparators were any alternative treatment options available in the NHS without VIT. Included outcomes were systemic reactions, local reactions, mortality, anxiety related to the possibility of future allergic reactions, health-related quality of life (QoL) and adverse reactions (ARs) to treatment. Cost-effectiveness outcomes included cost per quality-adjusted life-years (QALYs) gained. Because of the small number of published randomised controlled trials (RCTs), no meta-analyses were conducted. A de novo economic model was developed to assess the cost-effectiveness of PhVIT plus high-dose antihistamine (HDA) plus adrenaline auto-injector (AAI) plus avoidance advice in relation to two comparators. RESULTS:A total of 1065 citations were identified, of which 266 full-text papers were obtained. No studies were identified that compared PhVIT with any of the outlined comparators. When these criteria were widened to include different protocols and types of PhVIT administration, four RCTs and five quasi-experimental studies were identified for inclusion. The quality of included studies was poor, and none was conducted in the UK. Eight studies reported re-sting data (systemic reactions ranged from 0.0% to 36.4%) and ARs (systemic reactions ranged from 0.0% to 38.1% and none was fatal). No included studies reported quality of life. No published economic evidence relevant to the decision problem was identified. The manufacturer of PhVIT did not submit any clinical effectiveness or cost-effectiveness evidence to the National Institute for Health and Clinical Excellence in support of PhVIT. The results of the Assessment Group's (AG) base-case analysis show that the comparison of PhVIT + HDA + AAI versus AAI + HDA yields an incremental cost-effectiveness ratio (ICER) of £18,065,527 per QALY gained; PhVIT + HDA + AAI versus avoidance advice only yields an ICER of £7,627,835 per QALY gained. The results of the sensitivity analyses and scenario analyses showed that the results of the base-case economic evaluation were robust for every plausible change in parameter made. The results of the 'High Risk of Sting Patients' subgroup analysis show that PhVIT + HDA + AAI dominates both AAI + HDA and avoidance advice only (i.e. is less expensive and more effective). The 'VIT Anxiety QoL Improvement' subgroup analysis shows that PhVIT + HDA + AAI versus HDA + AAI has an ICER of £23,868 per QALY gained, and PhVIT + HDA + AAI versus avoidance advice only yields an ICER of £25,661 per QALY gained. LIMITATIONS:This review is limited to the use of Pharmalgen in the treatment of hymenoptera venom allergy and therefore does not assess the effectiveness of VIT in general. CONCLUSIONS:The current use of PhVIT in clinical practice in the NHS appears to be based on limited and poor-quality clinical effectiveness research. Available evidence indicates that sting reactions following the use of PhVIT are low and that the ARs related to treatment are minor and easily treatable. The results of the AG's de novo economic evaluation demonstrate that PhVIT + AAI + HDA compared with AAI + HDA and with avoidance advice only yields ICERs in the range of £8-20M per QALY gained. Two subgroups ('High Risk of Sting Patients' and 'VIT Anxiety QoL Improvement') were considered in the economic evaluation and the AG concludes that the use of PhVIT + AAI + HDA may be cost-effective in both groups. Future research should focus on clearly identifying groups of patients most likely to benefit from treatment and ensure that clinical practice is focussed on these groups. Furthermore, given the paucity of UK data in this area it would be informative if data could be collected routinely when VIT is administered in the NHS (e.g. rates of systemic adverse reactions to VIT, rates of systemic reactions to bee/wasp stings). FUNDING:The National Institute for Health Research Health Technology Assessment programme.
Bee Venom Immunotherapy: Current Status and Future Directions.
Zahirović Abida,Luzar Jernej,Molek Peter,Kruljec Nika,Lunder Mojca
Clinical reviews in allergy & immunology
Bee venom immunotherapy is the main treatment option for bee sting allergy. Its major limitations are the high percentage of allergic side effects and long duration, which are driving the development of novel therapeutic modalities. Three general approaches have been evaluated including the use of hypoallergenic allergen derivatives, adjunctive therapy, and alternative delivery routes. This article reviews preclinical and clinical evidence on the therapeutic potential of these new therapies. Among hypoallergenic derivatives, hybrid allergens showed a markedly reduced IgE reactivity in mouse models. Whether they will offer therapeutic benefit over extract, it is still not known since clinical trials have not been carried out yet. T cell epitope peptides have proven effective in small clinical trials. Major histocompatibility complex class II restriction was circumvented by using long overlapping or promiscuous T cell epitope peptides. However, the T cell-mediated late-phase adverse events have been reported with both short and longer peptides. Application of mimotopes could potentially overcome both T cell- and IgE-mediated adverse events. During this evolution of vaccine, there has been a gain in safety. The efficacy was further improved with the use of Toll-like receptor-activating adjuvants and delivery systems. In murine models, the association of allergen Api m 1 with cytosine-guanosine rich oligonucleotides stimulated strong T-helper type-1 response, whereas its encapsulation into microbubbles protected mice against allergen challenge. An intralymphatic administration of low-dose vaccine has shown the potential to decrease treatment from 5 years to only 12 weeks. Bigger clinical trials are needed to follow up on these results.
Ciszowski Krzysztof,Mietka-Ciszowska Aneta
Hymenoptera are the large group of insects which includes honey-bees, bumble-bees, paper wasps, hornets, ants. Female hymenoptera possess specialized stinging apparatus with which they inject their venom into prey's or intruder's body. It could be life-threatening for people sensitive to the venom. The hymenoptera venom consists of mixture of biologically active substances, eg. enzymes (phospholipases, hialuronidase), peptides (melittin, apamin, mastoparans, bombolitins) and low-molecular-weight compounds (biogenic amines, acetylcholine, carbohydrates, lipids, free amino acids). Several types of reactions are possible to develop after stinging by hymenopteran insects: (1) non-allergic local reaction (pain, small oedema, redness at the site of the sting); allergic reactions: (2) large local reaction (extensive local swelling, exceeding 10 cm, persisting longer than 24 hours) and (3) anaphylaxis (generalized urticaria, bronchospasm, hypotension, cardiovascular collapse, loss of consciousness); (4) systemic toxic reaction (oedema, vomits, diarrhoea, headache, hypotension, seizures, altered mental status); (5) unusual reactions (cardiac ischaemia, encephalomyelitis et al.). Therapeutic management after stings includes removing of the stinger (bee stings), local remedies (ice-packs, topical steroids) and prevention and treatment of an anaphylactic shock (epinephrine, general steroids, beta-mimetics, fluid resuscitation, oxygen therapy). In the present review types of reaction after hymenoptera stings were described with special interest of anaphylactic and toxic reactions as well as therapeutic management after stings.
The sting of the honeybee: an allergic perspective.
Brown Tyson C,Tankersley Michael S
Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology
OBJECTIVE:To provide a focused understanding of the uniqueness and special considerations of honeybee allergy. DATA SOURCES:A PubMed search using the keywords honeybee, allergy, and hypersensitivity yielded the initial relevant articles. Additional significant sources cited in the reference lists of the initial articles were also used. STUDY SELECTION:More than 130 articles were reviewed, and the most relevant references were selected for inclusion in this article. RESULTS:The honeybee differs from other flying Hymenoptera from both an entomologic and allergic standpoint. The entomology literature is not often consulted by the allergist when addressing avoidance of honeybees. Beekeepers are a particular population at risk for honeybee exposure and allergy. Venom composition, sting mechanism, diagnostic evaluation, and immunotherapy efficacy and safety all have unique considerations specific to the honeybee. CONCLUSIONS:Honeybee is a significant cause of venom hypersensitivity. By understanding unique behaviors of honeybees, proper avoidance measures may be addressed with patients. Honeybee venom is complex, and the delivery mechanism provides for a large but often variable amount of injected venom. Diagnosis of honeybee allergy by imperfect skin and serologic testing further complicated by cross-reactivity is often difficult. Generally, honeybee immunotherapy is less safe and less effective than for other flying Hymenoptera. Efforts to improve testing and immunotherapy are under way.
[Poisoning by bee sting].
de Roodt Adolfo R,Salomón Oscar D,Orduna Tomás A,Robles Ortiz Luis E,Paniagua Solís Jorge F,Alagón Cano Alejandro
Gaceta medica de Mexico
Among the human pathologies produced by venomous animals, bee stings constitute the largest number of accidents in several countries, exceeding the mortality rate caused by other venomous animals such as snakes, spiders or scorpions. The clinical picture after the bee sting may include anaphylaxis or poisoning. The latter is produced by massive attacks and is a serious problem that may put the patient's life at risk. People that are poisoned display hemolysis, rhabdomiolysis and acute renal failure that together with other systemic failures can bring about death. The knowledge of the physiopathological mechanisms involved in the massive attack of bees is crucial for health care professionals as to date we do not have antivenoms with proven clinical efficacy. In this review we include the bee's biological aspects, venom composition and its relation with the occurrence and severity of accidents as well as epidemiological data that can be useful for this type of accidents.
[Allergy and neurotoxicity induced by bee sting. Case report and literature review].
Valencia Zavala Martha Patricia,Sánchez Olivas Jesús Alberto,Sánchez Olivas Manuel Anastasio,Montes Montes José,Duarte Díaz Rosa Janet,León Oviedo Cristóbal
Revista alergia Mexico (Tecamachalco, Puebla, Mexico : 1993)
Under the heading of this subject we deal with stings by arthropods, making of bees, commenting on the composition of the poisons and the different local and general reactions that are differences that exist between the stings The venom contains many biologically active components such as melitin, phospholipase A2, apamin, mast cell degranulation peptide, hyaluronidase, histamine, and dopamine. That neurotoxic venom secretory phospholipases A2 (sPLA2) have specific receptors in brain membranes called N-type receptors that are likely to play a role in the molecular events leading to neurotoxicity of these proteins. The sPLA2 found in honeybee venom is neurotoxic and binds to this receptor with high affinity. Poneratoxin is small neuropeptide found in the venom of arthropod (bee). It is stored in the venom reservoir as a inactive 25 residue peptide. Here we describe both chemically synthesized poneratoxin, insect larvae were paralyzed by injection of either of the purified toxins. These toxins are used in research as molecular probes, targeting with high affinity selected ion channel subtypes. As such, they are very useful for understanding the mechanism of synaptic transmission. Poneratoxin affects the voltage-dependent sodium channels and blocks the synaptic transmission in the insect central nervous system in a concentration-dependent manner; we think that in the human this is same.
Hymenopterid bites, stings, allergic reactions, and the impact of hurricanes on hymenopterid-inflicted injuries.
Diaz James H
The Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society
Hymenopterid stings and subsequent allergic reactions are a common indication for emergency department visits worldwide. Unrecognized anaphylactic reactions to hymenopterid stings by apids, or bees, and vespids, or wasps, are a significant cause of sudden and unanticipated deaths outdoors in young people, with and without atopic histories. Insect bites and stings, often complicated by allergic reactions or skin infections, by community-acquired pathogens, such as methicillin-resistant Staphylococcus aureus, are common sources of morbidity following hurricanes, tropical storms, and prolonged flooding. This article will review and critically analyze the descriptive epidemiology and outcomes of hymenopterid bites, stings, and allergic reactions, especially following hurricanes and prolonged flooding disasters; stratify the immunologic reactions to hymenopterid stings by clinical severity and outcomes; and present current recommendations for management, prophylaxis, and prevention of hymenopterid stings and reactions.
Immunology of Bee Venom.
Elieh Ali Komi Daniel,Shafaghat Farzaneh,Zwiener Ricardo D
Clinical reviews in allergy & immunology
Bee venom is a blend of biochemicals ranging from small peptides and enzymes to biogenic amines. It is capable of triggering severe immunologic reactions owing to its allergenic fraction. Venom components are presented to the T cells by antigen-presenting cells within the skin. These Th2 type T cells then release IL-4 and IL-13 which subsequently direct B cells to class switch to production of IgE. Generating venom-specific IgE and crosslinking FcεR1(s) on the surface of mast cells complete the sensitizing stage in allergic individuals who are most likely to experience severe and even fatal allergic reactions after being stung. Specific IgE for bee venom is a double-edged sword as it is a powerful mediator in triggering allergic events but is also applied successfully in diagnosis of the venom allergic patient. The healing capacity of bee venom has been rediscovered under laboratory-controlled conditions using animal models and cell cultures. The potential role of enzymatic fraction of bee venom including phospholipase A2 in the initiation and development of immune responses also has been studied in numerous research settings. Undoubtedly, having insights into immunologic interactions between bee venom components and innate/specific immune cells both locally and systematically will contribute to the development of immunologic strategies in specific and epitope-based immunotherapy especially in individuals with Hymenoptera venom allergy.
Fitzgerald Kevin T,Flood Aryn A
Clinical techniques in small animal practice
The medically important groups of Hymenoptera are the Apoidea (bees), Vespoidea (wasps, hornets, and yellow jackets), and Formicidae (ants). These insects deliver their venom by stinging their victims. Bees lose their barbed stinger after stinging and die. Wasps, hornets, and yellow jackets can sting multiple times. Most deaths related to Hymenoptera stings are the result of immediate hypersensitivity reactions, causing anaphylaxis. Massive envenomations can cause death in nonallergic individuals. The estimated lethal dose is approximately 20 stings/kg in most mammals. Anaphylactic reactions to Hymenoptera stings are not dose dependent or related to the number of stings. Bee and wasp venoms are made up primarily of protein. Conversely, fire ant venoms are 95% alkaloids. Four possible reactions are seen after insect stings: local reactions, regional reactions, systemic anaphylactic responses, and less commonly, delayed-type hypersensitivity. Clinical signs of bee and wasp stings include erythema, edema, and pain at the sting site. Occasionally, animals develop regional reactions. Onset of life-threatening, anaphylactic signs typically occur within 10 minutes of the sting. Diagnosis of bee and wasp stings stem from a history of potential contact matched with onset of appropriate clinical signs. Treatment of uncomplicated envenomations (stings) consists of conservative therapy (antihistamines, ice or cool compresses, topical lidocaine, or corticosteroid lotions). Prompt recognition and initiation of treatment is critical in successful management of anaphylactic reactions to hymenopteran stings. Imported fire ants both bite and sting, and envenomation only occurs through the sting. Anaphylaxis after imported fire ant stings is treated similarly to anaphylactic reactions after honeybee and vespid stings. The majority of Hymenopteran stings are self-limiting events, which resolve in a few hours without treatment. Because life-threatening anaphylactic reactions can progress rapidly, all animals stung should be closely monitored and observed. In the following review article, we will examine the sources and incidence, toxicokinetics, pathological lesions, clinical signs, diagnosis, treatment, and prognosis for dogs and cats suffering Hymenoptera stings.
Bee and wasp stings: reactions and anaphylaxis.
Smallheer Benjamin A
Critical care nursing clinics of North America
This article provides a brief introduction to the history of anaphylaxis and the order Hymenoptera, which is responsible for most reported sting-induced allergic reactions. The anatomic similarities and differences as well as inhabited similarities and differences between bees and wasps are discussed. The various types of allergic reactions and their manifestations are described. Treatment regimens ranging from home therapies and over-the-counter medications to prescription medications and emergency treatments are introduced. Education, avoidance, and venom-specific immunotherapy are discussed.
Large local reactions and systemic reactions to insect stings: Similarities and differences.
Tripolt Patrik,Arzt-Gradwohl Lisa,Čerpes Urban,Laipold Karin,Binder Barbara,Sturm Gunter Johannes
BACKGROUND:Large local reactions (LLR) to Hymenoptera stings were considered as IgE-mediated late-phase inflammatory reactions. However, in older studies, most patients with LLR were skin test positive, but only around 50% had detectable sIgE determined by the RAST system. METHODS:Data of 620 patients were evaluated retrospectively: 310 patients who suffered from LLR and 310 patients with previous systemic sting reactions (SSR). We aimed to clarify if sIgE can generally be detected by the CAP system in patients with LLR; sIgE levels and clinical parameters were compared between patients with LLR and SSR. RESULTS:Positive sIgE levels were detected in 80.7% of patients with LLR, and in 95.2% of patients with SSR (p<0.001). Of the 310 patients with LLR, 80.6% had a LLR with a size of 10-20cm, whereas 19.4% had swellings >20cm, with a mean duration of seven days. In only 2.9% of patients, LLRs occurred after stings on the trunk, while 14.8% of SSR resulted from stings on this site (p<0.001). Similarly, LLR were also less frequent on the capillitium compared to SSR (8.1% versus 26.2%; p = 0.035). CONCLUSIONS:LLR usually persisted over seven days and about one fifth of patients had swellings greater than 20cm. Contrary to SSR, LLR were less frequently observed on the capillitium and on the trunk. In most patients with LLR, sIgE could be detected. However, total IgE and sIgE levels to bee or vespid venom did not differ between patients with LLR and SSR.
Bee sting envenomation severe cases in Manaus, Brazilian Amazon: clinical characteristics and immune markers of case reports.
Mendonça-da-Silva Iran,Monteiro Wuelton Marcelo,Sachett Jacqueline Almeida Gonçalves,Barbosa Endila Souza,Cordeiro-Dos-Santos Marcelo,Lacerda Marcus Vinícius Guimarães,Melo Gisely Cardoso,Costa Allyson Guimarães,Val Fernando Fonseca Almeida
Revista da Sociedade Brasileira de Medicina Tropical
Bee venom is a natural toxin composed of several peptides. Massive envenoming causes severe local and systemic reactions. We report two cases of severe bee envenomation, of which one was fatal. We also describe clinical characteristics and immune markers. Both victims suffered from respiratory distress, renal failure, rhabdomyolysis, and shock. They required invasive mechanical ventilation, vasoactive drugs, and renal replacement therapy. Moreover, serum levels of chemokines, cytokines, and cell-free circulating nucleic acids demonstrated an intense inflammatory process. Massive envenoming produced systemic injury in the victims, with an uncontrolled inflammatory response, and a more significant chemotactic response in the fatal case.
Idioventricular rhythm and shock after a honeybee sting.
Franco-Lugo Desireé,Uribe-Vallarta Denise A,Bernal-Contreras Karen D,Vargas-Abonce Valerie P,Soto-Pérez-De-Celis Enrique,Rivera-Figueroa Jaime,Cuevas-Ramos Daniel,Gómez-Pérez Francisco J,Gómez-Sámano Miguel Á
Archivos de cardiologia de Mexico
OBJECTIVE:The objective of this study was to describe the case of a 19-year-old male presenting with bradycardia and hypotension after a honeybee sting making a review of the literature and pathophysiology of the cardiovascular and electrocardiogram (EKG) changes after a bee sting. METHODS:The patient's airway was inspected and secured. Electrocardiogram with an idioventricular rhythm at 41' bpm. Oxygen was administered, an intravenous access was established, and the transcutaneous pacemaker leads were placed on the chest of the patient, then published guidelines management was induced. RESULTS:The EKG showed idioventricular rhythm at a rate of 41 beats/min that resolved to a normal sinus rhythm after treatment. CONCLUSIONS:A full and prompt cardiovascular evaluation should be performed in all patients presenting to the emergency department after a bee sting, and published guidelines regarding the management of bradycardia and anaphylaxis should be followed to achieve successful outcomes.
Bee- and Wasp-Venom Sensitization in Schoolchildren of High- and Low-Socioeconomic Status Living in an Urban Area of Indonesia.
Amaruddin Aldian I,Koopman Jan Pieter R,Muhammad Munawir,Versteeg Serge A,Wahyuni Sitti,van Ree Ronald,Yazdanbakhsh Maria,Hamid Firdaus,Sartono Erliyani
International archives of allergy and immunology
BACKGROUND:There is not much known about venom allergy in tropical regions. Here, we studied the prevalence of specific IgE (sIgE) and skin prick test (SPT) reactivity and reported sting-related symptoms, in high- and low-socioeconomic status (SES) schoolchildren living in urban city of Makassar in Indonesia. METHODS:Children from high- (n = 160) and low- (n = 165) SES schools were recruited. Standardized questionnaires were used to record information on allergic disorders as well as sting-related symptoms. Parasitic infection, SPT reactivity, and sIgE to Apis mellifera (bee-venom) as well as Vespula spp. (wasp-venom) were assessed. RESULTS:SPT reactivity to bee- and wasp-venom was 14.3 and 12.7%, while the prevalence of sIgE was 26.5 and 28.5%, respectively. When SES was considered, prevalence of SPT to bee- and wasp-venom was higher in high-SES than in low-SES schoolchildren (bee: 22.8 vs. 5.7%, p < 0.001; and wasp: 19.6 vs. 5.7%, p < 0.001). Conversely, sIgE to both venoms was lower in high-SES than in low-SES (bee: 19 vs. 34%, p = 0.016; and wasp: 19 vs. 38%, p = 0.003). Furthermore, among SPT positive subjects, considerable proportion had no detectable sIgE to bee- (65.85%) or wasp-venom (66.67%). Altogether the sensitizations were rarely translated into clinical reaction, as only 1 child reported significant local reaction after being stung. No association with parasitic infections was found. CONCLUSIONS AND CLINICAL RELEVANCE:Sensitization against bee- or wasp-venom is quite prevalent among schoolchildren in Indonesia. The discordance between SPT and sIgE might suggest the direct (non-IgE) effect of venoms in skin reactivity. Recorded sensitizations had poor clinical relevance as they rarely translated into clinical symptoms.
Insect Migration and Changes in Venom Allergy due to Climate Change.
Demain Jeffrey G
Immunology and allergy clinics of North America
Insects are highly successful animals. They have limited ability to regulate their temperature and therefore will expand range in response to warming temperatures. Climate change and associated rising global temperature is impacting the range and distribution of stinging insects. There is evidence that many species are expanding range toward the poles, primarily in response to warming. With expanded distribution of stinging insects, increased interaction with humans is anticipated with consequently increased rates of sting-related reactions and need for intervention. This article focuses on evidence that insects are expanding their range in response to warming temperature, increasing likelihood of human interaction.
Omalizumab ensures compatibility to bee venom immunotherapy (VIT) after VIT-induced anaphylaxis in a patient with systemic mastocytosis.
Gülsen Askin,Ruëff Franziska,Jappe Uta
BACKGROUND:Systemic reactions and anaphylaxis due to Hymenoptera venoms occur in up to 7.5% of the European population. Fatal sting reactions are very rare. Serum tryptase levels should be measured in all patients with a history of severe reactions in order to detect mastocytosis and to determine the risk of severe reactions to venom immunotherapy (VIT). The risk to experience severe or even fatal anaphylaxis due to insect stings is quite high in patients with mastocytosis. Therefore, lifelong VIT is recommended in these highly threatened patients. Multicenter studies involving a large population report that up to 20% of patients undergoing VIT have intolerance and systemic reactions to immunotherapy. Some of these side effects occur repeatedly and cannot be managed by standard treatment. A pre-treatment with the anti-IgE antibody omalizumab was useful in many cases. However, omalizumab is not approved for the indication anaphylaxis. Therefore, there is still no defined protocol for omalizumab pre-treatment, and the optimal duration, dosage as well as long-time benefits are still unclear. CASE REPORT:We present a 60-year-old female patient with mastocytosis who developed a severe anaphylactic reaction during initiation of bee VIT. Serum tryptase was elevated, and a KIT mutation D816V was subsequently confirmed. Component-resolved diagnostic tests revealed specific IgE antibodies to recombinant Api m 1 only. The patient was treated with 150 mg omalizumab, administered subcutaneously 5 weeks, 3 weeks, and 1 week prior to re-start of immunotherapy and for 2 months in parallel to VIT. Updosing was done by a 7-day rush schedule. During this period, no anaphylactic reaction developed, and the bee VIT was well tolerated with up to 200 µg bee venom. The patient is currently in the 3 year of treatment and tolerates the treatment very well. CONCLUSION:Omalizumab may be used as a premedication in patients with mastocytosis who do not tolerate VIT. Although there is no consensus on the treatment protocol, treatment for 2 - 6 months is considered adequate. The long-term benefits of such treatment require further research.
New Biomarkers of Venom Allergy in a Group of Inflammation Factors.
Packi Kacper,Matysiak Joanna,Matuszewska Eliza,Bręborowicz Anna,Kycler Zdzisława,Matysiak Jan
International journal of environmental research and public health
venom allergy significantly affects the quality of life. Due to the divergences in the results of the available test and clinical symptoms of patients, the current widely applied diagnostic methods are often insufficient to classify patients for venom immunotherapy (VIT). Therefore it is still needed to search for new, more precise, and accurate diagnostic methods. Hence, this research aimed to discover new biomarkers of venom allergy in a group of inflammation factors using set of multi-marker Bioplex panel. The adoption of a novel methodology based on Luminex/xMAP enabled simultaneous determination of serum levels of 37 different inflammatory proteins in one experiment. The study involved 21 patients allergic to wasp and/or honey bee venom and 42 healthy participants. According to univariate and multivariate statistics, soluble CD30/tumor necrosis factor receptor superfamily, member 8 (sCD30/TNFRSF8), and the soluble tumor necrosis factor receptor 1 (sTNF-R1) may be considered as effective prognostic factors, their circulating levels were significantly decreased in the allergy group (-value < 0.05; the Area Under the Curve (AUC) ~0.7; Variable Importance in Projection (VIP) scores >1.2). The obtained results shed new light on the allergic inflammatory response and may contribute to modification and improvement of the diagnostic and monitoring methods. Further, large-scale studies are still needed to explain mechanisms of action of studied compounds and to definitively prove their usefulness in clinical practice.
Kounis Syndrome and Multiorgan Failure Following Multiple Wasp Stings.
Navaradnam Piratheepan,Suganthan Navaneethakrishnan,Kumanan Thirunavukarasu,Sujanitha Vathulan,Mayorathan Uruthirapasupathi
Wasp and bee stings are common in Sri Lanka, and systemic envenomation causes a spectrum of clinical manifestations that includes simple local allergic reaction to life-threatening multiple organ injury or failure. However, wasp toxin-induced acute myocardial infarction is very rare in the literature. Here, we describe a pregnant lady with mass wasp stings who developed toxin-induced acute myocardial infarction with multiorgan injury. The treating physician should anticipate the complications of massive envenomation following multiple wasp stings.
[Treatment report of three cases of multiple wasp stings].
Wu Z H,Sun A F,Xue J K,Zhi S C,Zhang H Y,Zhao G J,Lu Z Q
Zhonghua lao dong wei sheng zhi ye bing za zhi = Zhonghua laodong weisheng zhiyebing zazhi = Chinese journal of industrial hygiene and occupational diseases
From September to November 2019, three patients with Hornet stings were admitted to hospital with acute anaphylaxis and various degrees of organ dysfunction. After hemoperfusion combined with continuous hemodialysis and hormone pulse therapy, 1 patient was successfully treated and 2 patients were not cured. Bee Stings can cause systemic allergic reactions and toxic reactions. In severe cases, acute anaphylaxis, rhabdomyolysis, intravascular hemolysis, abnormal coagulation, and acute liver and kidney injury may occur, myocardial damage and other multi-organ function damage or even failure, is a clinical acute and critical illness, mortality is higher. Through the analysis of the diagnosis and treatment process of these 3 cases, the experience is summarized: the Bee sting should be treated as soon as possible, the early prevention and treatment of multiple organ dysfunction, the choice of accurate blood purification and comprehensive treatment, can effectively improve the prognosis, increase the success rate of treatment.
Lethality of Honey Bee Stings to Heavily Armored Hornets.
Gu Gaoying,Meng Yichuan,Tan Ken,Dong Shihao,Nieh James C
The heat ball defense of honey bees against their sympatric hornet predators is a classic and spectacular outcome of a co-evolutionary race. Hundreds of bees can encapsulate a hornet within a large ball that kills it with elevated heat. However, the role of stinging in this defense has been discounted, even though sting venom is an important weapon in bees. Surprisingly, no studies have tested the role of bee sting venom alone or in conjunction with elevated temperature on hornet survival. We surveyed dead hornets found near and inside colonies and found stings retained in hornet bodies, most often in an intersegmental neck-like region, the veracervix. Experimentally stinging hornets in this region with and guards significantly increased hornet mortality. The combination of sting venom and elevated heat ball temperature (44 °C) was the most lethal, although there was no synergistic interaction between sting venom and temperature. As expected, hornet mortality increased when they were stung more often. The average amount of venom per insect species and the length of stinger lancets correlated with insect mass. Sting venom thus remains important in the arms race between bees and their hornet predators.
Acute coronary artery dissection after multiple bee stings.
Del Rio-Pertuz Gaspar,Correa-Guerrero Jose,Abuabara-Franco Emilio,Argueta-Sosa Erwin E,Abohelwa Mostafa,Kounis Nicholas G,Nugent Kenneth
Proceedings (Baylor University. Medical Center)
The occurrence of an acute coronary syndrome following an anaphylactic or anaphylactoid reaction is known as Kounis syndrome. Previous reports of Kounis syndrome described an acute coronary syndrome due either to vasospasm or atherosclerotic rupture of a coronary artery in the presence of cutaneous manifestation from the anaphylactic reaction. We report a case of a 33-year-old man who presented with anterior wall acute myocardial infarction immediately after honeybee stings without the presence of cutaneous manifestations other than the bee sting lesions. Emergent coronary arteriography revealed dissection of the proximal left anterior descending artery, which was treated with balloon dilation with an excellent outcome.
[Mortality related to honey-bee stings in Mexico from 1988 to 2009].
Becerril-Ángeles Martìn,Núñez-Velázquez Marco,Arias-Martìnez María Isabel,
Revista alergia Mexico (Tecamachalco, Puebla, Mexico : 1993)
BACKGROUND:Honeybee stings can cause toxic and allergic reactions that may lead to severe symptoms, and sometimes to death. Mexico is the third worldës honey country exporter and sixth producer. Due to the arrival of Africanized bees into Mexico in 1986, the National Program for Control of Africanized Bee (NPCAB) was created, in order to reduce the socioeconomic and sanitary impact from the new bee species. OBJECTIVE:To report deaths related to honey-bee sting in Mexico, from 1988 to 2009. METHODS:Reports gathered from offices of the National Program for the Control of Africanized Honey-Bee throughout the country, were used to show the number of deaths related to honey-bee stings which occurred in Mexico from 1988 to 2009. RESULTS:People suffering from multiple honey-bee stings were reported in all the states of the country. Between 1988 and 1998 there were 360 honey-bee related accidents, involving over 5000 people. From 1988 to 2009 there were 480 demised persons with an annual average of 21.8. Regarding age, people over 50 years were the most affected ones. The largest number of fatal cases, 340, occurred from 1990 to 1999, with an annual average of 34, and between 2000 and 2009, the number of cases decreased to 118. CONCLUSIONS:There was an average of 21 annual death cases related to honey-bee stings from 1988 to 2009. Toxic reactions caused by multiple stings are the most likely cause of death in the majority of cases. Fatal cases occurred mainly in people older than 50 years. There was a decrease in the mortality rate associated to honey-bee stings in the last decade.
The culprit insect but not severity of allergic reactions to bee and wasp venom can be determined by molecular diagnosis.
Gattinger Pia,Lupinek Christian,Kalogiros Lampros,Silar Mira,Zidarn Mihaela,Korosec Peter,Koessler Christine,Novak Natalija,Valenta Rudolf,Mittermann Irene
BACKGROUND:Allergy to bee and wasp venom can lead to life-threatening systemic reactions. The identification of the culprit species is important for allergen-specific immunotherapy. OBJECTIVES:To determine a panel of recombinant bee and wasp allergens which is suitable for the identification of bee or wasp as culprit allergen sources and to search for molecular surrogates of clinical severity of sting reactions. METHODS:Sera from eighty-seven patients with a detailed documentation of their severity of sting reaction (Mueller grade) and who had been subjected to titrated skin testing with bee and wasp venom were analyzed for bee and wasp-specific IgE levels by ImmunoCAPTM. IgE-reactivity testing was performed using a comprehensive panel of recombinant bee and wasp venom allergens (rApi m 1, 2, 3, 4, 5 and 10; rVes v 1 and 5) by ISAC chip technology, ImmunoCAP and ELISA. IgG4 antibodies to rApi m 1 and rVes v 5 were determined by ELISA and IgE/IgG4 ratios were calculated. Results from skin testing, IgE serology and IgE/IgG4 ratios were compared with severity of sting reactions. RESULTS:The panel of rApi m 1, rApi m 10, rVes v 1 and rVes v 5 allowed identification of the culprit venom in all but two of the 87 patients with good agreement to skin testing. Severities of sting reactions were not associated with results obtained by skin testing, venom-specific IgE levels or molecular diagnosis. Severe sting reactions were observed in patients showing < 1 ISU and < 2kUA/L of IgE to Api m 1 and/or Ves v 5. CONCLUSION:We identified a minimal panel of recombinant bee and wasp allergens for molecular diagnosis which may permit identification of bee and/or wasp as culprit insect in venom-sensitized subjects. The severity of sting reactions was not associated with parameters obtained by molecular diagnosis.
Bee Updated: Current Knowledge on Bee Venom and Bee Envenoming Therapy.
Pucca Manuela B,Cerni Felipe A,Oliveira Isadora S,Jenkins Timothy P,Argemí Lídia,Sørensen Christoffer V,Ahmadi Shirin,Barbosa José E,Laustsen Andreas H
Frontiers in immunology
Honey bees can be found all around the world and fulfill key pollination roles within their natural ecosystems, as well as in agriculture. Most species are typically docile, and most interactions between humans and bees are unproblematic, despite their ability to inject a complex venom into their victims as a defensive mechanism. Nevertheless, incidences of bee stings have been on the rise since the accidental release of Africanized bees to Brazil in 1956 and their subsequent spread across the Americas. These bee hybrids are more aggressive and are prone to attack, presenting a significant healthcare burden to the countries they have colonized. To date, treatment of such stings typically focuses on controlling potential allergic reactions, as no specific antivenoms against bee venom currently exist. Researchers have investigated the possibility of developing bee antivenoms, but this has been complicated by the very low immunogenicity of the key bee toxins, which fail to induce a strong antibody response in the immunized animals. However, with current cutting-edge technologies, such as phage display, alongside the rise of monoclonal antibody therapeutics, the development of a recombinant bee antivenom is achievable, and promising results towards this goal have been reported in recent years. Here, current knowledge on the venom biology of Africanized bees and current treatment options against bee envenoming are reviewed. Additionally, recent developments within next-generation bee antivenoms are presented and discussed.
[Wasp and bee stings with serious consequences].
Smeding C,van Iterson M,Gamadia L E,Innemee G,Heidt J
Nederlands tijdschrift voor geneeskunde
Wasp and bee stings can lead to allergic reactions, anaphylaxis, Kounis syndrome, toxicity, organ failure and, in rare cases, cardiac arrest. In the Netherlands, fatal complications as a result of wasp or bee stings are rare; here we describe three recent severe cases. We diagnosed two patients with anaphylactic shock due to multiple wasp stings, resulting in cardiac arrest and death. Taking the number of stings (> 100) in one of these cases into account, a differential diagnostic consideration was 'exogenic toxic shock'. Considering the severe reaction with fatal outcome in both patients we cannot rule out the existence of indolent mastocytosis. The third patient developed grade 1 anaphylaxis and severe facial swelling, but survived. In this article we describe the pathophysiological background, treatment, diagnostics and desensitisation therapy.
Acute kidney injury complicating bee stings - a review.
Silva Geraldo Bezerra da,Vasconcelos Adolfo Gomes,Rocha Amanda Maria Timbó,Vasconcelos Vanessa Ribeiro de,Barros João de,Fujishima Julye Sampaio,Ferreira Nathália Barros,Barros Elvino José Guardão,Daher Elizabeth De Francesco
Revista do Instituto de Medicina Tropical de Sao Paulo
Bee stings can cause severe reactions and have caused many victims in the last years. Allergic reactions can be triggered by a single sting and the greater the number of stings, the worse the prognosis. The poisoning effects can be systemic and can eventually cause death. The poison components are melitin, apamin, peptide 401, phospholipase A2, hyaluronidase, histamine, dopamine, and norepinephrine, with melitin being the main lethal component. Acute kidney injury (AKI) can be observed in patients suffering from bee stings and this is due to multiple factors, such as intravascular hemolysis, rhabdomyolysis, hypotension and direct toxicity of the venom components to the renal tubules. Arterial hypotension plays an important role in this type of AKI, leading to ischemic renal lesion. The most commonly identified biopsy finding in these cases is acute tubular necrosis, which can occur due to both, ischemic injury and the nephrotoxicity of venom components. Hemolysis and rhabdomyolysis reported in many cases in the literature, were demonstrated by elevated serum levels of indirect bilirubin and creatine kinase. The severity of AKI seems to be associated with the number of stings, since creatinine levels were higher, in most cases, when there were more than 1,000 stings. The aim of this study is to present an updated review of AKI associated with bee stings, including the currently advised clinical approach.
Honeybee Stings in the Era of Killer Bees: Anaphylaxis and Toxic Envenomation.
Rahimian Rombod,Shirazi F Mazda,Schmidt Justin O,Klotz Stephen A
The American journal of medicine
BACKGROUND:Twenty-six years after the arrival of "killer bees" in Arizona, the entire state with the exception of high elevations in the north is populated with this bee variety and 11 people have died at the scene of massive bee attacks. METHODS:Because of the aggressive behavior of these bees we studied bee stings reported to the Arizona Poison and Drug Information Center. The center received 399 calls regarding 312 victims of bee stings from January 2017 to June 2019. Calls originated from private residences and emergency centers. RESULTS:Stings occurred at victims' home residences in 272 (84.7%) of cases and 24 (7.5%) in public areas; 251 people suffered 1 sting; 42 individuals, 2-10 stings, 4 had 11-49 stings, and 13 individuals had >50 stings (so-called massive stinging). Three individuals were admitted to intensive care units (ICU) and one 35-year-old man died of anaphylaxis after 1 sting; moderate clinical effects occurred in 32 individuals including 6 admitted to the hospital but not in the intensive care unit. Anaphylaxis occurred in 30 (9.6%) of individuals, 16 receiving 1 sting. Toxic effects, tachycardia, elevated creatinine, or rhabdomyolysis occurred in 13 (4.2%) individuals. CONCLUSIONS:In the past, individuals stung more than 50 times were beekeepers working with European honeybees, whereas, in the current era, single as well as massive stings are the result of feral "killer bees." This change in epidemiology requires a new approach to sting victims: those with massive stinging should be evaluated and observed for anaphylaxis and serial laboratory values obtained for days to detect the toxic effects of envenomation.
The impact of the blood glucose levels of non-diabetic critically ill patients on their clinical outcome.
Koyfman Leonid,Brotfain Evgeni,Erblat Alexander,Kovalenko Inna,Reina Yair-Yaish,Bichovsky Yoav,Borer Abraham,Friger Michael,Frenkel Amit,Klein Moti
Anaesthesiology intensive therapy
BACKGROUND:Stress hyperglycaemia is thought to result from a hormonal response (release of catecholamines, glucocorticoids, glucagon, etc.) following stress, sepsis or trauma. Although stress hyperglycaemia is a very common finding in critically ill populations, there are many non-diabetic critically ill patients who do not develop a hyperglycaemic stress response to trauma or acute illness. We suggest that the lack of a hyperglycaemic stress response during the acute phase of a critical illness may correlate significantly with the clinical outcome of these critically ill non-diabetic patients. METHODS:This was a retrospective study of 700 non-diabetic critically ill patients admitted to the general intensive care unit (ICU) at Soroka Medical Center, Beer Sheva, Israel. We analyzed the clinical impact of the blood glucose levels of these patients measured during their first week of ICU hospitalization on their clinical outcome. RESULTS:Age, male gender, and the Acute Physiology and Chronic Health Evaluation (APACHE) score were found to be independent risk factors for new episodes of infection during the patients' stay in the ICU. Age and the APACHE and Sequential Organ Failure Assessment scores were found to be independent risk factors for intra-ICU mortality. In contrast, blood glucose analysis performed during the patients' stay in the ICU was not found to be an independent predictor for new infectious events or for mortality during the ICU stay. CONCLUSION:Our study did not demonstrate an association between blood glucose levels and clinical outcomes in non-diabetic critically ill patients.
Bench-to-bedside review: Glucose and stress conditions in the intensive care unit.
Losser Marie-Reine,Damoisel Charles,Payen Didier
Critical care (London, England)
The physiological response to blood glucose elevation is the pancreatic release of insulin, which blocks hepatic glucose production and release, and stimulates glucose uptake and storage in insulin-dependent tissues. When this first regulatory level is overwhelmed (that is, by exogenous glucose supplementation), persistent hyperglycaemia occurs with intricate consequences related to the glucose acting as a metabolic substrate and as an intracellular mediator. It is thus very important to unravel the glucose metabolic pathways that come into play during stress as well as the consequences of these on cellular functions. During acute injuries, activation of serial hormonal and humoral responses inducing hyperglycaemia is called the 'stress response'. Central activation of the nervous system and of the neuroendocrine axes is involved, releasing hormones that in most cases act to worsen the hyperglycaemia. These hormones in turn induce profound modifications of the inflammatory response, such as cytokine and mediator profiles. The hallmarks of stress-induced hyperglycaemia include 'insulin resistance' associated with an increase in hepatic glucose output and insufficient release of insulin with regard to glycaemia. Although both acute and chronic hyperglycaemia may induce deleterious effects on cells and organs, the initial acute endogenous hyperglycaemia appears to be adaptive. This acute hyperglycaemia participates in the maintenance of an adequate inflammatory response and consequently should not be treated aggressively. Hyperglycaemia induced by an exogenous glucose supply may, in turn, amplify the inflammatory response such that it becomes a disproportionate response. Since chronic exposure to glucose metabolites, as encountered in diabetes, induces adverse effects, the proper roles of these metabolites during acute conditions need further elucidation.
A case of Kounis syndrome after a hornet sting and literature review.
Ralapanawa Dissanayake Mudiyanselage Priyantha Udaya Kumara,Kularatne Senanayake Abeysinghe Mudiyanselage
BMC research notes
BACKGROUND:Acute coronary syndrome after hymenoptera stings or exposure to environment toxins is referred to as the Kounis syndrome or allergic myocardial ischaemia with or without infarction. We report a case of hornet (Vespa affinis) sting causing Kounis syndrome in Sri Lanka and present a review of literature. CASE PRESENTATION:A 60-year -old female with diabetes mellitus and known allergy to bee venom was stung by a hornet on the right hand. Within 30 minutes she developed hypotension and wide spread T wave inversion in the 12 leads ECG that remained unchanged about 5 hours and reversed back to normal. CONCLUSION:Hymenoptera stings can induce acute coronary syndrome either by direct effect of venom constituents on the coronary endothelium or through inflammatory mediators induced allergic reaction on coronary vasculature. Early recognition of Kounis syndrome is needed in hornet stings to implement necessary treatments.
Elevated and cross-responsive CD1a-reactive T cells in bee and wasp venom allergic individuals.
Subramaniam Sumithra,Aslam Aamir,Misbah Siraj A,Salio Mariolina,Cerundolo Vincenzo,Moody D Branch,Ogg Graham
European journal of immunology
The role of CD1a-reactive T cells in human allergic disease is unknown. We have previously shown that circulating CD1a-reactive T cells recognize neolipid antigens generated by bee and wasp venom phospholipase, and here tested the hypothesis that venom-responsive CD1a-reactive T cells associate with venom allergy. Circulating T cells from bee and wasp venom allergic individuals, before and during immunotherapy, were exposed to CD1a-transfected K562 cells in the presence of wasp or bee venom. T-cell response was evaluated based on IFNγ, GM-CSF, and IL-13 cytokine production. Venom allergic individuals showed significantly higher frequencies of IFN-γ, GM-CSF, and IL-13 producing CD1a-reactive T cells responsive to venom and venom-derived phospholipase than healthy individuals. Venom-responsive CD1a-reactive T cells were cross-responsive between wasp and bee suggesting shared pathways of allergenicity. Frequencies of CD1a-reactive T cells were initially induced during subcutaneous immunotherapy, peaking by weeks 5, but then reduced despite escalation of antigen dose. Our current understanding of venom allergy and immunotherapy is largely based on peptide and protein-specific T cell and antibody responses. Here, we show that lipid antigens and CD1a-reactive T cells associate with the allergic response. These data have implications for mechanisms of allergy and approaches to immunotherapy.
Wasp sting-induced acute kidney injury.
Dhanapriya Jeyachandran,Dineshkumar Thanigachalam,Sakthirajan Ramanathan,Shankar Palaniselvam,Gopalakrishnan Natarajan,Balasubramaniyan Thoppalan
Clinical kidney journal
BACKGROUND:Wasp stings are a common form of envenomation in tropical countries, especially in farmers. The aim of this study was to document the clinical presentation, treatment and outcomes of patients with acute kidney injury (AKI) due to multiple wasp stings in a tertiary care hospital. METHODS:We conducted a retrospective observational study of patients with multiple wasp stings and AKI at the Department of Nephrology between July 2011 and August 2015. The clinical features, laboratory data, treatment details and outcomes were noted. RESULTS:A total of 11 patients were included. All were from rural areas. All of them were males with age ranging from 21 to 70 years, mean age 45 ± 23 years. Six had oliguria and two had hypotension. All 11 patients had evidence of rhabdomyolysis and three also had hemolysis. Ten patients required hemodialysis with a mean number of hemodialysis sessions of 8.7 ± 2.8. Renal biopsy carried out on four patients, showed acute interstitial nephritis (AIN) in one patient, acute tubular necrosis (ATN) in two patients, and one patient had both AIN and ATN. The two patients with AIN were given steroids, while all other patients were managed with supportive measures. One patient died within 48 h of presentation due to shock. At a mean follow-up of 24 months, one had progressed to chronic kidney disease and the remaining nine had normal renal function. CONCLUSIONS:Wasp sting is an occupational hazard. AKI was most commonly due to rhabdomyolysis. Early renal biopsy is indicated in those patients who do not respond to supportive measures. Timely dialysis and steroid in the case of AIN improves renal survival.
Fatal Anaphylaxis to Yellow Jacket Stings in Mastocytosis: Options for Identification and Treatment of At-Risk Patients.
Vos Byrthe J P R,van Anrooij Bjorn,van Doormaal Jasper J,Dubois Anthony E J,Oude Elberink Joanne N G
The journal of allergy and clinical immunology. In practice
BACKGROUND:Patients with indolent systemic mastocytosis (ISM) are at risk for severe anaphylactic reactions to yellow jacket (YJ) stings while demonstration of sensitization can be challenging because specific IgE (sIgE) levels are regularly below 0.35 kU/L. The implication of missing YJ allergy is illustrated by a case of fatal anaphylaxis. OBJECTIVE:To explore the natural course of YJ venom allergy and the diagnostic accuracy and therapeutic consequence of YJ venom sIgE in patients with ISM. METHODS:All patients with ISM seen from 1981 to 2015 (n = 243) were evaluated on the number of YJ stings, reaction severity, and sensitivity and specificity of YJ venom sIgE. YJ venom allergic patients without mastocytosis served as control (n = 313). RESULTS:A total of 153 patients with ISM were stung during adult life. The first systemic reaction was more often severe in patients with ISM than in patients without mastocytosis (69.9% vs 22.0%) and reactions recurred in 40 of 41 re-stung patients with ISM. ISM reactors showed lower YJ venom sIgE levels than nonmastocytosis reactors (0.61 vs 4.83 kU/L; P < .001) and asymptomatic sensitization was exceedingly rare. In ISM the current clinical threshold of 0.35 kU/L yields a sensitivity and specificity of 77.6% and 87.5%, respectively. The optimal diagnostic accuracy is achieved at 0.17 kU/L (sensitivity, 83.6%; specificity, 85.0%). CONCLUSIONS:The high rate of severe reactions and the fatal case underscore the importance of adequate diagnostic sensitivity of sIgE in patients with ISM. The sensitivity of sIgE can be ameliorated by lowering the threshold to 0.17 kU/L, retaining good specificity. We recommend sIgE screening in all patients with ISM and discussing immunotherapy when YJ venom sIgE exceeds 0.17 kU/L.
Pre-hospital treatment of bee and wasp induced anaphylactic reactions: a retrospective study.
Ruiz Oropeza Athamaica,Mikkelsen Søren,Bindslev-Jensen Carsten,Mortz Charlotte G
Scandinavian journal of trauma, resuscitation and emergency medicine
BACKGROUND:Bee and wasp stings are among the most common triggers of anaphylaxis in adults representing around 20% of fatal anaphylaxis from any cause. Data of pre-hospital treatment of bee and wasp induced anaphylactic reactions are sparse. This study aimed to estimate the incidence of bee and wasp induced anaphylactic reactions, the severity of the reactions and to correlate the pre-hospital treatment with the severity of the anaphylactic reaction. METHODS:Retrospective and descriptive study based on data from the Mobile Emergency Care Units (MECUs) in the Region of Southern Denmark (2008 only for Odense and 2009-2014 for the whole region). Discharge summaries with diagnosis related to anaphylaxis according to the International Classification of Diseases 10 (ICD-10) were reviewed to identify bee and wasp induced anaphylactic reactions. The severity of the anaphylactic reaction was assessed according to Sampson's severity score and Mueller's severity score. Treatment was evaluated in relation to administration of adrenaline, glucocorticoids and antihistamine. RESULTS:We identified 273 cases (Odense 2008 n = 14 and Region of Southern Denmark 2009-2014 n = 259) of bee and wasp induced anaphylaxis. The Incidence Rate was estimated to 35.8 cases per 1,000,000 person year (95% CI 25.9-48.2) in the Region of Southern Denmark during 2009-2014. According to Sampson's severity score, 65% (n = 177) of the cases were graded as moderate to severe anaphylaxis (grade 3-5). Almost one third of cases could not be graded according to Mueller's severity score. Adrenaline was administrated in 54% (96/177) of cases with moderate to severe anaphylaxis according to Sampson's severity score, compared to 88% receiving intravenous glucocorticoids (p < 0.001) and 91% receiving intravenous antihistamines (p < 0.001). Even in severe anaphylaxis (grade 5) adrenaline was administered in only 80% of the cases. CONCLUSION:Treatment with adrenaline is not administered in accordance with international guidelines. However, making an assessment of the severity of the anaphylactic reaction is difficult in retrospective studies.
Bee or Wasp Sting.
Hon Kam Lun,Leung Alexander K C
Wounds : a compendium of clinical research and practice
While jogging in a local park in Hong Kong, a 55-year-old, previously healthy man was stung on the ventral aspect of his right wrist. The tiny stinger was gently removed with nail cutters and examined under a microscope at 80x magni cation; plucking the stinger is ill- advised as this may inject more venom into the wounded site. Two days after stinging, the microscopic appearance of the stinger con rmed the diagnosis to be from a bee instead of a wasp or other insect. A simple method of con rming the nature of insect stings and an overview of Hymenoptera stings and their management are provided herein.
Bee and wasp stings in Deniyaya; a series of 322 cases.
Witharana E W R A,Wijesinghe S K J,Pradeepa K S M,Karunaratne W A I P,Jayasinghe S
The Ceylon medical journal
OBJECTIVES:To describe wasp and bee species that sting humans, analyse risk factors and clinical features. METHODS:A prospective observational study was conducted on patients presenting to Base Hospital Deniyaya with suspected bee and wasp stings from 2011 to 2013. Data were gathered using a questionnaire and specimens of offending insects collected for identification. When the insect specimen was unavailable, identification was made by the victim selecting (without prompting) from several dead specimens presented by the first author. RESULTS:There were 322 patients (mean age: 42.5 years, SD: 15.1, 173 [53.7%] males). Insects were brought by 55 (17%) and 267 (83%) were identified using specimens. All occurred during day-time, 142 (44.1%) during August and September, and 200 victims (62%) were tea plantation workers. Majority (78.9%) reported a localized painful self-limiting swelling without systemic features and 15 (4.6%) developed anaphylactic shock. None died. Five specimens were available from those in anaphylactic shock (four Apis dorsata, one Ropalidia marginata). Vespa tropica stinging caused a characteristic skin lesion. Of the 55 specimens, 46 (83.6%) were Apis dorsata (Giant honey-bee, ''Bambara''), 8 (14.5%) Vespa tropica (Greater banded hornet, ''Debara'') and one Ropalidia marginata (Paper wasp, ''Kaladuruwa''). CONCLUSIONS:Only three hymenoptera species stings were reported. Risk factors included day-time outdoor activities, occupation (tea plantation workers) and period of year. The latter may be due to pollen season when the insects are found in abundance. Only 4.6% of the patients developed anaphylactic shock. Vespa tropica stings led to a unique skin lesion.
Hymenoptera Venom Allergy: How Does Venom Immunotherapy Prevent Anaphylaxis From Bee and Wasp Stings?
Sahiner Umit Murat,Durham Stephen R
Frontiers in immunology
Hymenoptera stings may cause both local and systemic allergic reactions and even life threatening anaphylaxis. Along with pharmaceutical drugs and foods, hymenoptera venom is one of the most common causes of anaphylaxis in humans. To date, no parameter has been identified that may predict which sensitized people will have a future systemic sting reaction (SSR), however some risk factors, such as mastocytosis and age >40 years are known. Venom immunotherapy (VIT) is the most effective method of treatment for people who had SSR, which is shown to be effective even after discontinuation of the therapy. Development of peripheral tolerance is the main mechanism during immunotherapy. It is mediated by the production of blocking IgG/IgG4 antibodies that may inhibit IgE dependent reactions through both high affinity (FcεRI) and low affinity (FcεRII) IgE receptors on mast cells, basophils and B cells. The generation of antigen specific regulatory T cells produces IL-10 and suppresses Th2 immunity and the immune responses shift toward a Th1-type response. B regulatory cells are also involved in the production of IL-10 and the development of long term immune tolerance. During VIT the number of effector cells in target organs also decreases, such as mast cells, basophils, innate type 2 lymphocytes and eosinophils. Several meta-analyses and randomized controlled studies have proved that VIT is effective for preventing SSR to a sting and improves the quality of life. In this review, the risk of SSR in venom allergy and how VIT changed this risk are discussed.
Evaluation on treatment of sustained low-efficiency hemodialysis against patients with multiple organ dysfunction syndrome following wasp stings.
Ye Ting-Ting,Gou Rong,Mao Ya-Ni,Shen Jian-Ming,He Dong,Deng Yan-Yan
BACKGROUND:To evaluate the treatment of sustained low-efficiency hemodialysis (SLED) against patients with multiple organ dysfunction syndrome (MODS) following wasp stings. METHODS:Clinical data of 35 patients with MODS following wasp stings were retrospectively analysed. These patients were divided into three groups according to the treatment strategy used: 1) hemodialysis (HD) group, 2) continuous veno-venous hemofiltration (CVVH)/HD group, and 3) SLED/HD group. The clinical parameters, treatment outcome, and safety findings were compared among the three groups. RESULTS:The recovery rate (76.92% vs 77.78% vs 91.67%, p = 0.621) and mortality rate (15.38% vs 11.11% vs 8.33%, p = 0.999) were similar among the three groups. When compared to the HD group, patients treated with CVVH/HD or SLED/HD required a shorter period of time to enter into polyuria stage [(24.7 ± 4.3) days vs (20.2 ± 4.7) days vs (18.2 ± 3.0) days, F = 9.11, p = 0.0007], and required a shorter time for serum creatinine to return to normal [(45.7 ± 13.4) days vs (33.1 ± 9.4) days vs (31.9 ± 9.8), F = 5.83, p = 0.0069]; while such parameters had no significant differences between SLED/HD group and CVVH/HD group. The adverse events of hypotension and arrhythmia were found in the HD group, while no adverse events were reported in the SLED/HD and CVVH/HD groups. There was no significant difference in the cost of blood purification treatment between the SLED/HD group and HD group. CONCLUSION:The use of SLED, CVVH and HD provided a comparable recovery and survival rates in patients with MODS secondary to wasp stings. Compared to HD, the use of SLED is recommended as a treatment strategy because of the efficacy on recover of renal function, satisfactory safety outcome, as well as the reasonable treatment cost.
Efficacy analysis of methylprednisolone plus adrenaline to treat wasp sting injury.
Xia Jing-Biao,Xu Shuang-Shuang,Zhang Xiang-Wen,Zhong Wen-Qi,Peng Ai-Min
Saudi medical journal
OBJECTIVE:To observe the effect of methylprednisolone (MP) plus adrenaline to treat patients injured by wasp stings. METHODS:This study was carried out at The First College of Clinical Medical Science, China Three Gorges University, Yichang, Hubei Province, China, from June to November 2008. A total of 45 cases were divided into 2 groups. The MP was used alone in the control group, and MP plus adrenaline was used in the observation group. We compared the clinical effect between the 2 groups. RESULTS:The alanine aminotransferase (ALT) (64.05 +/- 59.31 versus 124.14 +/- 80.01 U/L), and creatine kinase isoenzyme (CKMB) (90.32 +/- 85.19 versus 216.68 +/- 277.58 umol/L) levels of the observation group were significantly lower than those of the control group. The length of hospital stay of the observation group was significantly shorter than that of the control group (7.23 +/- 2.93 versus 11.23 +/- 8.02), while complications from the wasp sting were fewer than those of the control group. In addition, the level of peripheral blood leukocytes was positively correlated with the number of stings (r=0.733, p=0.001), levels of ALT and CKMB (r=0.627, p=0.001, and r=0.705, p=0.001), and length of hospital stay (r=0.667, p=0.001). CONCLUSION:Allergic and inflammatory responses play an important role in addition to the direct effect of wasp venom on the human body. Compared with MP alone, early combination of adrenaline helps to further inhibit the diffusion of allergy and inflammatory cytokines, and therefore reduce the severity of injury.
Risk factors for severe systemic sting reactions in wasp ( spp.) and honeybee () venom allergic patients.
Clinical and translational allergy
BACKGROUND:Hymenoptera stings are a major cause of anaphylaxis. Various risk factors are discussed in literature. This study aims to investigate potential risk factors for severe sting reactions in wasp ( spp.) and honeybee () venom allergic patients and analyses the correlation between diagnostic test results and the severity of the allergic reaction. METHODS:480 patients suffering from wasp or honeybee venom allergy were included in this retrospective case series. Only individuals allergic to spp. but not to other vespids such as were considered. The severity of their systemic field sting reaction was analysed with regard to the amount of specific IgE antibodies to whole venom extracts and to major allergens of honeybee and/or wasp venom. Furthermore, the following potential risk factors for severe sting reactions were examined: age, sex, latency time, skin symptoms, baseline serum tryptase levels and the concentration of venom inducing a positive intracutaneous test. RESULTS:The two following indicators for severe systemic sting reactions in honeybee and wasp venom allergic patients have been identified: a short latency time and the absence of skin symptoms. The patient's age and baseline serum tryptase levels have been found to positively correlate with the grade of the sting reaction only in individuals allergic to wasp venom. No correlation could be found between the degree of sensitisation and the severity of the allergic reaction. Neither the amount of specific IgE antibodies to whole venom extracts nor to major allergens were significantly associated with the severity of the sting reaction. CONCLUSION:The clinical history is essential for the allergological workup and therapeutic decision on Hymenoptera venom allergies. A short latency time and the absence of skin symptoms are indicators for severe systemic sting reactions, followed by the patient's age and baseline serum tryptase levels.
Biopanning of allergens from wasp sting patients.
Chai Lin,Yang Xianyi,Liu Mei,Liu Chunyan,Han Limei,Guo Hui,Li Changsheng,Sun Yuwen,Li Xiaoyan,Xiao Min,Fang Zhicheng
OBJECTIVE:Wasp venom is a potentially important natural drug, but it can cause hypersensitivity reactions. The purpose of the present study was to systematically study the epitopes of wasp venom. METHODS:Using a random 12-peptide phage library, we performed antibody-binding epitope panning on ten serum samples from wasp sting victims at 3 h and 4 days after the sting. The panning epitopes were identified by high-throughput sequencing and matched with wasp venom proteins by BLAST. The panned antibody-binding epitopes were verified by ELISA. RESULTS:A total of 35 specific potential wasp venom epitopes in 4 days were identified. Amongst them, twelve peptide epitopes were matched with nine wasp venom proteins, namely, vitellogenin precursor, hexamerin 70b precursor, venom carboxylesterase-6 precursor, MRJP5, major royal jelly protein 8 precursor, venom acid phosphatase Acph-1 precursor, phospholipase A2, venom serine protease 34 precursor, and major royal jelly protein 9 precursor. The changes in serum IgM antibodies induced by wasp venom were confirmed by ELISA based on the 12 peptide epitopes. CONCLUSION:The nine wasp venom proteins are potential allergens, which should be excluded or modified in the potential biomedical applications of wasp venom.
[Wasp and bee stings].
Gortzak K,Gortzak R A Th
Nederlands tijdschrift voor tandheelkunde
Occasionally a dentist is confronted with a painful, red facial swelling which has suddenly appeared, with no signs of a dental cause. In addition to the other possible causes, one should consider the possibility of an insect bite, especially in the summer months. The consequences of an insect bite or sting are often underestimated. Hymenopterae (wasps and honeybees) stings are not generally serious in nature, but can result in severe systemic medical complications, such as an allergic reaction. Dentists who are confronted with a patient with an insect bite or sting must provide the patient with adequate information and if necessary take measures in order to prevent further complications.
Diversity of compounds in Vespa spp. venom and the epidemiology of its sting: a global appraisal.
Herrera Cayetano,Leza Mar,Martínez-López Emma
Archives of toxicology
Poisonous animals imply a risk to human life, because their venom is a complex mixture of low molecular weight components, peptides and proteins. Hornets use the venom for self-defence, to repel intruders and to capture prey, but they can cause poisoning and allergic reactions to people. In particular, they seem to be a health problem in the countries where they are native due to their sting, which in the most severe cases can lead to severe or fatal systemic anaphylaxis. But this situation is being an emerging problem for new countries and continents because hornet incursions are increasing in the global change scenario, such as in Europe and America. Furthermore, 55 detailed cases of hornet sting were found in 27 papers during the current review where 36.4% died due to, mainly, a multi-organ failure, where renal failure and liver dysfunction were the most common complications. Moreover, the great taxonomic, ecological diversity, geographical distribution and the wide spectrum of pathophysiological symptoms of hornets have been the focus of new research. Considering this, the present systematic review summarizes the current knowledge about the components of Vespa venom and the epidemiology of its sting to serve as reference for the new research focused on the development of techniques for diagnosis, new drugs and treatments of its sting.
Honeybee and wasp venom allergy: Sensitization and immunotherapy.
Adib-Tezer Hanan,Bayerl Christiane
Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG
Hymenoptera venom allergy is the most common cause of anaphylactic reactions in adults. In children, it is the second most common cause after food-related anaphylaxis. Such reactions are primarily due to stings by honeybees (Apis) and certain social wasps (Vespula vulgaris and Vespula germanica in particular). Especially in adults, stings are frequently associated with severe anaphylaxis. Established diagnostic methods including molecular tests allow for greater success rates in terms of determining the insect actually responsible for triggering the anaphylactic reaction. Sensitization to both venoms, or a history of systemic sting reaction without any evidence of sensitization, complicate the decision regarding treatment. Venom immunotherapy (VIT) is a safe and effective causal treatment.
Treatment with a combination of omalizumab and specific immunotherapy for severe anaphylaxis after a wasp sting.
Palgan K,Bartuzi Z,Gotz-Zbikowska M
International journal of immunopathology and pharmacology
Hymenoptera venom anaphylaxis after bee or wasp sting is a common problem that affects about 1.2 percent to 3.5 percent of the general population. Venom-specific immunotherapy (VIT) is an established mode of treatment for immunoglobulin (Ig) E-mediated Hymenoptera venom allergy. However, VIT may often be associated with immediate anaphylaxis which can lead to treatment withdrawal. Several cases published in recent years suggest that omalizumab, used as add-on therapy may be able to prevent anaphylaxis during VIT. We report the case of a 30-year-old woman, suffering from mild persistent asthma, who had a history of severe anaphylactic reactions after yellow jacket sting, and after eating peanuts, contact with guinea pig hair, and i.v. administration of dexamethasone natrium phosphate. Initial specific immunotherapy had to be stopped due to severe anaphylaxis (hypotension, dyspnea, and angioedema). The immunotherapy was reintroduced accompanied by the anti-immunoglobulin (Ig) E monoclonal antibody omalizumab. Subcutaneous omalizumab 150 mg was initiated 4 weeks after the anaphylaxis incident and 1 day before the resumption of VIT. Rush treatment was uneventful, and the usual cumulative dose of 111.1 microg was successfully reached. The combination of omalizumab and VIT is a valid option of therapy for these patients and could reduce asthma and food allergy symptoms.
Clinical Evaluation of High-Volume Hemofiltration with Hemoperfusion Followed by Intermittent Hemodialysis in the Treatment of Acute Wasp Stings Complicated by Multiple Organ Dysfunction Syndrome.
Si Xiaoyun,Li Jingjing,Bi Xiaohong,Wu Lan,Wu Xiaoyan
Multiple organ dysfunction syndrome (MODS) is a rare complication of wasp stings. Currently, there is no standardized treatment for MODS secondary to multiple wasp stings, although blood purification techniques are often used. This study aimed to analyze our experiences of using intermittent hemodialysis (IHD) with or without high-volume hemofiltration (HVHF) for treating acute wasp stings complicated by MODS. In this retrospective study, 36 patients with wasp stings complicated by MODS received either IHD combined with hemoperfusion, or HVHF (ultrafiltration flow rate, 70 mL/kg/h) combined with hemoperfusion for 5 days followed by IHD. Clinical symptoms, blood biochemical parameters, duration of mechanical ventilation, use of vasoactive agents, duration of hospital stay and survival rate were recorded, and Acute Physiology and Chronic Health Evaluation II (APACHE II) and multiple organ dysfunction (MOD) scores estimated. Patients treated with HVHF followed by IHD appeared to exhibit a faster recovery than those receiving IHD alone, as evidenced by superior improvements in MOD (4.29±1.08 vs. 2.27±1.07) and APACHE II (7.09±2.62 vs. 4.20±1.69) scores (P < 0.05). Patients treated with HVHF had significantly lower myoglobin, creatine kinase-MB, lactate dehydrogenase, bilirubin and creatinine levels than patients treated with IHD alone. In addition, the durations of hospital stay (13.15±2.77 vs. 27.92±3.18 days), vasopressor use (1.76±0.24 vs. 3.43 ± 1.01 days), mechanical ventilation (3.02±1.63 vs. 5.94 ± 2.11 days) and oliguria (6.57±2.45 vs. 15.29 ± 3.51 days) were reduced, and renal function more often recovered (85.1% vs. 53.1%), in the HVHF group compared with the IHD group (P < 0.05). These results raise the possibility that HVHF plus IHD may be superior to IHD alone for the treatment of acute wasp stings complicated by MODS; additional prospective studies are merited to explore this further.
Venomous Bites, Stings, and Poisoning: An Update.
Warrell David A
Infectious disease clinics of North America
This article discusses the epidemiology, prevention, clinical features, and treatment of venomous bites by snakes, lizards, and spiders; stings by fish, jellyfish, echinoderms, insects, and scorpions; and poisoning by ingestion of fish, turtles, and shellfish. Invertebrate stings cause fatalities by anaphylaxis, secondary to acquired hypersensitivity (Hymenoptera, such as bees, wasps, and ants; and jellyfish), and by direct envenoming (scorpions, spiders, jellyfish, and echinoderms). Simple preventive techniques, such as wearing protective clothing, using a flashlight at night, and excluding venomous animals from sleeping quarters, are of paramount importance to reduce the risk of venomous bites and stings.
[Expert consensus statement on standardized diagnosis and treatment of wasp sting in China].
Chinese Society Of Toxicology Poisoning And Treatment Of Specialized Committee ,Hubei Emergency Medicine Committee Of Chinese Medical Association ,Hubei Provincial Poisoning And Occupational Disease Union ,Yang Xianyi,Xiao Min
Zhonghua wei zhong bing ji jiu yi xue
OBJECTIVE:To improve the diagnosis and treatment of wasp sting, summarize the experience, the experts from Chinese Society of Toxicology Poisoning and Treatment of Specialized Committee, Hubei Emergency Medicine Committee of Chinese Medical Association and Hubei Provincial Poisoning and Occupational Disease Union made the Expert consensus statement on standardized diagnosis and treatment of wasp stings in China on the development of domestic and oversea in this field. The consensus statement emphasized the idea of staged treatment, different treatments at different stages, and strived to achieve bundling and individuation. To achieve the four pairs of different concept as earlier as possible, the "two early" (early assessment and early treatment), the "two anti" (anti-anaphylaxis and anti-shock), namely the "two hormone" (adrenaline and glucocorticoid) and the "two hua" (hydration and alkalization), we could avoid or reduce subsequent organ failures, significantly shorten the course and improve prognosis of wasp sting victims.
Clinical features of severe wasp sting patients with dominantly toxic reaction: analysis of 1091 cases.
Xie Cuihong,Xu Shabei,Ding Fengfei,Xie Minjie,Lv Jiagao,Yao Jihua,Pan Dengji,Sun Qian,Liu Chenchen,Chen Tie,Li Shusheng,Wang Wei
BACKGROUND:Massive wasp stings have been greatly underestimated and have not been systematically studied. The aim of this study was to identify the clinical features and treatment strategies of severe wasp stings. METHODS AND FINDINGS:A multicenter retrospective study was undertaken in 35 hospitals and medical centers including 12 tertiary care hospitals and 23 secondary care hospitals in the Hubei Province, China. The detailed clinical data of 1091 hospitalized wasp sting patients were investigated. Over three-fourths (76.9%) of the cases had 10 or more stings and the in-hospital mortality of patients was 5.1%. Forty-eight patients died of organ injury following toxic reactions to the stings, whereas six died from anaphylactic shock. The in-hospital mortality in patients with >10 stings was higher than that of ≤10 stings (5.2% vs. 1.0%, p = 0.02). Acute kidney injury (AKI) was seen in 21.0% patients and most patients required blood purification therapy. Rhabdomyolysis was seen in 24.1% patients, hemolysis in 19.2% patients, liver injury in 30.1% patients, and coagulopathy in 22.5% patients. Regression analysis revealed that high creatinine level, shock, oliguria, and anemia were risk factors for death. Blood purification therapy was beneficial for patients with ≥20 stings and delayed hospital admission of patients (≥4 hours after sting). CONCLUSIONS:In China, most patients with multiple wasp stings presented with toxic reactions and multiple organ dysfunction caused by the venom rather than an anaphylactic reaction. AKI is the prominent clinical manifestation of wasp stings with toxic reaction. High creatinine levels, shock, oliguria, and anemia were risk factors for death.
[Predictive value of MB isoenzyme of creatine kinase and poisoning severity score in the prognosis of patients with wasp sting].
Li Dahuan,Wang Tianzhong,Pan Meng,Zhang Honghua,Zhang Guoxiu
Zhonghua wei zhong bing ji jiu yi xue
OBJECTIVE:To explore the predictive value of MB isoenzyme of creatine kinase (CK-MB) and poisoning severity score (PSS) in the clinical prognosis of patients with wasp sting. METHODS:A retrospective study was conducted. The clinical data of patients who were stung by wasps admitted to emergency department of the First Affiliated Hospital of Henan University of Science and Technology from July 2017 to November 2019 were collected. The 24-hour acute physiology and chronic health evaluation II (APACHE II), CK-MB and PSS scores of the patients were collected after admission, and 28-day outcome was recorded. Spearman correlation analysis method was used to analyze the correlation between CK-MB and PSS score. Logistic regression model was used to construct joint predictors, and the receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of various indicators for 28-day prognosis of patients with wasp stings. RESULTS:Finally 90 patients were included in the analysis. There were 67 patients survived at 28 days, and 23 dead with the 28-day mortality of 25.6%. APACHE II score, CK-MB and PSS score in the death group were significantly higher than those in the survival group [APACHE II score: 19.7±2.7 vs. 13.7±2.3, CK-MB (U/L): 183 (151, 243) vs. 36 (21, 75), PSS score: 17.7±2.6 vs. 9.3±4.5, all P < 0.01]. The correlation analysis showed that CK-MB and PSS score were positively correlated (r = 0.843, P < 0.01). Logistic regression model fitted CK-MB and PSS score, and Hosmer-Lemeshow test showed that the model fitted well. ROC curve analysis showed that the area under ROC curve (AUC) of CK-MB for predicting 28-day outcome was 0.957, the sensitivity was 91.3%, and the specificity was 88.1%; the AUC of PSS score was 0.908, the sensitivity was 91.3%, and the specificity was 90.8%. The AUC of CK-MB combined with PSS score was 0.964, the sensitivity was 100%, and the specificity was 79.4%, indicating that CK-MB combined with PSS score had higher predictive value and higher sensitivity for 28-day prognosis of patients with wasp sting. CONCLUSIONS:High CK-MB level and high PSS score in early stage of wasp sting injury indicate poor prognosis. Both CK-MB and PSS score can be used as predictors for predicting the prognosis of patients with wasp stings. In addition, CK-MB combined with PSS score have greater predictive value.
Macroscopic hematuria in wasp sting patients: a retrospective study.
Wang Maohe,Prince Singh,Tang Yong,Zhong Xiang,Chen Shasha,Li Guisen,Wang Li,Wang Wei
BACKGROUND:Macroscopic hematuria after wasp sting has been reported in Asia to occur before acute kidney injury (AKI), and is often used by clinicians as a sign indicating the need for intensive care and blood purification therapy. However, there is no study on the clinical characteristics and prognosis of this symptom. METHODS:The clinical data of 363 patients with wasp sting admitted to Suining Central Hospital from January 2016 to December 2018 were retrospectively analyzed. At admission, the poisoning severity score (PSS) was used as the criterion for severity classification. According to the presence of macroscopic hematuria, the patients were divided into macroscopic hematuria and non-macroscopic hematuria group. RESULTS:Of the 363 wasp sting patients, 219 were male and 144 were female, with a mean age of 55.9 ± 16.3 years. Fifty-one (14%) had macroscopic hematuria, 39 (10.7%) had AKI, 105 (28.9%) had rhabdomyolysis, 61 (16.8%) had hemolysis, 45 (12.4%) went on to received hemodialysis, and 14 (3.9%) died. The incidence of AKI in macroscopic hematuria group was 70.6%, and oliguric renal failure accounted for 72.2%. Patients with macroscopic hematuria had significantly higher PSS (2.2 ± 0.5 vs. 1.1 ± 0.3, < .001). CONCLUSION:Macroscopic hematuria can be regarded as a surrogate marker of deteriorating clinical outcome following wasp stings. In wasp sting patients with symptoms of macroscopic hematuria or serum LDH higher than 463.5 u/L upon admission, the risk of AKI increases significantly, therefore hemodialysis should be considered. The PSS is helpful in early assessment of the severity of wasp sting patients.
Hemoperfusion plus continuous veno-venous hemofiltration in the treatment of patients with multiple organ failure after wasp stings.
The International journal of artificial organs
PURPOSE:This study aimed to evaluate the clinical effects of hemoperfusion plus continuous veno-venous hemofiltration in the treatment of patients with multiple organ failure after wasp stings and investigate its impacts on cytokines. METHODS:A total of 12 patients with multiple organ failure after wasp stings admitted to Xijing Hospital were included in the present study between January 2017 and January 2019. All patients received hemoperfusion plus continuous veno-venous hemofiltration treatment in addition to conventional treatment after admission. Procedure of treatment was conducted as the following: hemoperfusion (2 h/day) and followed by continuous veno-venous hemofiltration (22 h/day) for at least 5 days. Patients' clinical features, serum laboratory tests, and hemodynamic variables were monitored. The blood samples were taken to measure the changes of plasma cytokines. RESULTS:All 12 patients survived in the observation period. After hemoperfusion plus continuous veno-venous hemofiltration treatment, there were significant improvements in indicators of liver function, renal function, state of consciousness, and mediators in blood circulation, including alanine transaminase, aspartate transaminase, creatine kinase, blood urea nitrogen, serum creatinine, myoglobin, C-reactive protein, and so on. In these patients, acid-base metabolism returned to normal levels; Acute Physiology and Chronic Health Evaluation II score, Simplified Acute Physiology Score II score, and Sequential Organ Failure Assessment score lowered markedly. Furthermore, the plasma levels of interleukin 1β, interleukin 4, interleukin 6, interleukin 8, and interleukin 10 in these patients were significantly decreased; no significant change was shown in the level of tumor necrosis factor α. CONCLUSION:Our results revealed that hemoperfusion plus continuous veno-venous hemofiltration was effective in the management of patients with multiple organ failure after wasp sting via the non-specific removal of the wasp venom and inflammatory cytokines.
Interleukin-6 Gene Polymorphism and the Risk of Systemic Inflammatory Response Syndrome Caused by Wasp Sting Injury.
Sun Yuhui,Yang Jingning,Sun Yuwen,Chen Ping,Yao Wei,Meng Zhongji,Xiao Min,Qian Xin
DNA and cell biology
Previous studies have shown that serum levels of interleukin-6 (IL-6), which plays an important role in the development of systemic inflammatory response syndrome (SIRS), is significantly increased in wasp sting patients. However, the association between IL-6 gene variants and the risk of SIRS development in these patients is not clearly understood. In this study, we investigated the association between IL-6 gene polymorphism in the promoter region and the risk of SIRS in wasp sting patients. A total of 160 patients were divided into SIRS group and non-SIRS group (control), and evaluated for polymorphisms in IL-6 (-174G/C, -572G/C, -597G/A, and -634C/G), using DNA sequencing. The IL-6 serum levels were assessed using an enzyme-linked immunosorbent assay. Risk factors were analyzed by logistic regression analysis. We found that the IL-6 serum level was significantly higher in the SIRS group than in the control group (p < 0.001). A significant association was observed in the genotypic distribution of the IL-6 - 572G allele in the SIRS group, when compared with the control group [OR = 3.909 (1.906-8.019), p < 0.001], and SIRS is more likely to occur in wasp sting patients with more than 10 stings. Thus, the IL-6 - 572G allele and more than 10 stings can be used as predictors of risk of SIRS development in wasp sting patients.
Wasp venom and acute kidney injury: The mechanisms and therapeutic role of renal replacement therapy.
Gong Jianhua,Yuan Hai,Gao Zhao,Hu Fengqi
Toxicon : official journal of the International Society on Toxinology
Stinging accidents involving wasp venom are a notable cause of acute kidney injury (AKI) in Asia. However, very little attention has been paid to the understanding of the mechanisms involved in this type of AKI. The aims of this review are to explore the evidence for the mechanisms and the therapeutic role of renal replacement therapy of wasp venom and AKI. A systematic literature search was conducted using PubMed for the association among wasp venom and AKI. Wasp venom is a complex mixture of biologically active components, including enzymes, amines, and peptides. Wasp venom may induce local anaphylaxis reactions as well as systemic reactions such as AKI. AKI may develop as a result of direct nephrotoxic effects of the venom or secondary intravascular hemolysis and/or rhabdomyolysis. Histopathological features of renal biopsies predominantly include acute tubular necrosis and acute interstitial nephritis. Renal replacement therapy, which includes intermittent hemodialysis, hemoperfusion, plasmapheresis, continuous renal replacement therapy, and peritoneal dialysis, has been used to treat severe AKI cases induced by wasp stings. Continuous renal replacement therapy appears to provide more benefit than intermittent hemodialysis in the treatment of wasp sting-induced AKI. In this review, we summarize the existing evidence of the mechanisms and treatment for venom-induced AKI, with a particular emphasis on the role of renal replacement therapy in the management of severe AKI following massive wasp stings.