Children who have severe allergic reactions when stung by bees should receive venom immunotherapy

Children who have severe allergic reactions when stung by bees, wasps and other insects should receive venom immunotherapy, or allergy shots, to reduce the chance of future life-threatening reactions if a repeat sting should occur, said an allergist at UT Southwestern Medical Center at Dallas.

In an editorial published in today's issue of The New England Journal of Medicine, Dr. Rebecca Gruchalla, chief of the allergy division of internal medicine and associate professor of pediatrics at UT Southwestern, recommends the shots for children who have had a serious systemic allergic reaction to an insect sting.

Systemic allergic reactions go beyond the expected swelling and pain at the sting site and could include low blood pressure, tightness in the chest and swelling in the throat. These type reactions require immediate medical care due to their life-threatening nature, she said.

"Claritin isn't going to be able to fix this," Dr. Gruchalla said of the over-the-counter medicine used for seasonal allergies. "Severe reactions to stings and the stuffiness caused by ragweed are mediated by the same 'allergy antibody,' immunoglobulin E, but the clinical manifestations are very different.

"It's similar to having a food allergy. The majority of kids with documented food allergies have only mild hive reactions when they eat the 'culprit' food, but for those with a severe allergy, the reaction could be deadly."

The article accompanies a study by researchers from the Johns Hopkins Asthma and Allergy Center in Baltimore. Researchers found that children who had severe allergic reactions to bee stings and who were given the venom allergy shots were significantly less likely to suffer life-threatening reactions when restung, even if the repeat sting happened years later.

"The common belief has been that children typically outgrow insect sting allergies and for this reason, venom immunotherapy may not be needed. This study sets the record straight," Dr. Gruchalla said, adding that the therapy is not necessary for kids who suffer from allergic skin reactions such as hives.

"Hopefully now, since hard data have been provided, physicians will be able to move beyond previous misconceptions and endorse venom immunotherapy for these children most at risk," she said.

The culprits responsible for most of the reactions include honeybees, bumblebees, yellow jackets, yellow hornets, white-faced hornets, paper wasps and fire ants.

There are at least 40 fatal stings in the nation each year but it is likely that many deaths go unreported, Dr. Gruchalla said. Almost 1 percent of all children are reported to have a medical history of severe allergic reactions to insect stings, she said.