What does Hymenoptera refer to in medical terms?

From the Guidelines

Hymenoptera refers to an order of insects that includes bees, wasps, hornets, yellow jackets, and ants, which can cause allergic reactions in humans through their stings or bites, potentially leading to life-threatening anaphylaxis. This classification is medically significant because these insects can trigger mild local reactions or, in sensitive individuals, severe systemic allergic responses including anaphylaxis. Approximately 2-3% of adults and up to 1% of children have had a systemic reaction to a sting, and large local reactions occur in more than 5% of adults 1. When a person is stung by a hymenopteran insect, venom is injected that contains proteins which can trigger these reactions.

Key Points to Consider

• Treatment for hymenoptera stings typically includes removing the stinger (if present), applying ice to reduce swelling, taking antihistamines like diphenhydramine (25-50mg every 4-6 hours) for mild reactions, and using epinephrine auto-injectors (0.3mg for adults, 0.15mg for children) for severe allergic reactions.
• People with known severe allergies to hymenoptera should carry emergency medication and consider immunotherapy (allergy shots) to reduce sensitivity to these venoms over time.
• Immunotherapy with Hymenoptera venom is effective in dramatically reducing the risk of anaphylaxis to honeybee, yellow jacket, hornet, and wasp stings, as demonstrated by randomized, double-blind, placebo-controlled studies 1.
• The decision to continue or stop immunotherapy must be individualized, considering factors such as the severity of disease, benefits sustained from treatment, and convenience of treatment 1.

Recommendations

• Patients who have had a systemic reaction from an insect sting and evidence of venom-specific IgE should receive venom immunotherapy (VIT), as it greatly reduces the risk of systemic reactions in stinging insect–sensitive patients with an efficacy of up to 98% 1.
• VIT is recommended as safe and effective, even in patients who have had cardiac anaphylaxis, and has been effective in cases of delayed anaphylaxis after a sting.
• The duration of VIT should be determined by the physician and patient after considering the benefits and risks associated with discontinuing or continuing immunotherapy, with a typical treatment course of 5 years for Hymenoptera hypersensitivity.

From the Research

Definition of Hymenoptera

• Hymenoptera refers to an order of insects that includes bees, wasps, hornets, yellow jackets, and ants 2, 3, 4, 5, 6.
• The order is divided into several families, including Apidae (bees), Vespidae (wasps, hornets, and yellow jackets), and Formicidae (ants) 2, 3.

Medical Importance of Hymenoptera

• Hymenoptera stings can cause allergic reactions, ranging from mild local reactions to life-threatening anaphylaxis 2, 3, 4, 5, 6.
• The venom from Hymenoptera stings contains proteins and alkaloids, which can trigger allergic reactions 3.
• Anaphylaxis is a serious complication of Hymenoptera stings, and prompt recognition and treatment are critical to prevent serious outcomes 3, 4, 5, 6.

Types of Reactions to Hymenoptera Stings

• Local reactions: characterized by erythema, edema, and pain at the sting site 3.
• Regional reactions: characterized by more extensive swelling and redness beyond the sting site 3.
• Systemic anaphylactic responses: characterized by life-threatening symptoms such as difficulty breathing, rapid heartbeat, and fall in blood pressure 3, 4, 5, 6.
• Delayed-type hypersensitivity: a less common type of reaction that occurs several hours or days after the sting 3.