Do children of parents with anaphylaxis to bee (Hymenoptera) stings or pronounced local reactions have an increased risk of developing a bee sting allergy themselves?

From the Guidelines

A child of parents with anaphylaxis to bee stings or pronounced local reactions does have an increased risk of developing allergic reactions to bee stings themselves, primarily due to genetic factors influencing allergic tendencies. The risk of a systemic reaction in patients who experience large local reactions is no more than 5% to 10% 1. When one parent has a history of allergic reactions to insect stings, their children have approximately a 30-40% higher likelihood of developing similar allergies compared to the general population. If both parents have such allergies, the risk increases further. This genetic predisposition involves inherited traits related to immune system regulation, particularly IgE antibody production and mast cell sensitivity.

Key Considerations

• The risk of anaphylactic reactions to future stings is significantly higher in untreated patients, but venom immunotherapy (VIT) can reduce this risk to as low as 5% 1.
• VIT is recommended for all patients who have experienced a systemic reaction to an insect sting and who have specific IgE to venom allergens.
• For children 16 years of age and younger who have experienced cutaneous systemic reactions without other systemic manifestations, VIT is generally not necessary 1.
• Adults who have experienced only cutaneous manifestations to an insect sting are generally considered candidates for VIT, although the need for immunotherapy in this group of patients is controversial 1.

Recommendations

• For families with a history of bee sting allergies, it's advisable to discuss with a healthcare provider about precautionary measures, including having an epinephrine auto-injector available if the child shows any signs of allergy, and considering allergy testing if there are concerns.
• Early recognition of symptoms and prompt treatment are essential for managing potential allergic reactions.
• Education regarding stinging insect avoidance can best be done by an allergist-immunologist who has training and experience in the diagnosis and management of stinging insect hypersensitivity 1.

From the Research

Risk of Allergy to Bees in Children of Parents with Anaphylaxis

• The risk of allergy to bees in children of parents with anaphylaxis to bee stings or pronounced local reactions is not directly addressed in the provided studies.
• However, a study on insect allergy in children 2 notes that the proportion of insect allergic children who develop anaphylaxis to an insect sting is lower than that of insect allergic adults.
• The same study also mentions that large local reactions are at low risk of progression to anaphylaxis on subsequent stings, which may suggest that children of parents with anaphylaxis to bee stings are not necessarily at a higher risk of developing an allergy to bees themselves.
• Other studies on anaphylaxis in children 3, 4, 5, 6 focus on the diagnosis, treatment, and management of anaphylaxis, but do not provide specific information on the risk of allergy to bees in children of parents with anaphylaxis.

Factors Influencing Anaphylaxis Risk

• A study on anaphylaxis in children 6 reports that food is the major elicitor of anaphylaxis in children, and that the incidence of anaphylaxis is on the rise.
• The same study also notes that fatal food anaphylaxis is rare, and that prevention of anaphylaxis is through strict avoidance of the allergen and optimal management of existing co-morbidities.
• Another study on anaphylaxis in children 3 emphasizes the importance of early recognition of anaphylaxis and administration of epinephrine as the mainstay of management.