Not all children outgrow insect sting allergy

Most children who have allergic reactions to bee or wasp stings no longer have a reaction by the time they become adults, but about one in five remains allergic, a Johns Hopkins University research team has found.

Children treated with venom immunotherapy to reduce the risk of a serious reaction to bee stings, however, continue to benefit from the treatment even 10 to 20 years later, the team reports in this week’s New England Journal of Medicine.

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Dr. David B. K. Golden and his colleagues diagnosed allergy to insect stings in 1033 children between 1978 and 1985. For their new study, they contacted 512 of the original patients to find out how they reacted to stings they suffered between 1987 and 1999.

Stings occurred in 64 subjects who had undergone venom immunotherapy for an average of 3-1/2 years, and in 111 who had not. Three percent of the treated patients had fairly severe allergic reactions, compared with 17 percent of those in the untreated group.

Six patients, none of whom had been given immunotherapy, had more severe reactions to a recent sting than they had experienced previously. Among the 22 with moderate-to-severe reactions to the first sting, six had a similar reaction during the last episode.

Two patients who had been given immunotherapy had a moderate allergic reaction to a recent sting, while their original reaction had been severe.

Thus, Golden’s group concludes, the prolonged reduction in risk after treatment implies that children can stop venom immunotherapy after 3 to 5 years.

“Both the risk of allergic reaction to stings and the benefit of venom immunotherapy are greatest for the 40 percent of children with allergy to insect stings who originally had moderate-to-severe systemic reactions,” they add.

For the other 60 percent, venom immunotherapy seems to be unnecessary.

Given this “hard data,” doctors should “support the use of venom immunotherapy for the children most at risk,” Dr. Rebecca S. Gruchalla of the University of Texas Southwestern Medical Center in Dallas states in an accompanying editorial.

SOURCE: New England Journal of Medicine, August 12, 2004.

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