From the Guidelines
Anaphylaxis caused by bee venom is diagnosed based on clinical criteria, including acute onset of symptoms, involvement of skin and mucosal tissue, respiratory involvement, reduced blood pressure, and gastrointestinal symptoms.
Diagnostic Criteria
The diagnostic criteria for anaphylaxis include:
- Acute onset of illness (minutes to hours) with involvement of the skin, mucosal tissue, or both with either respiratory involvement or reduced blood pressure (BP)/associated symptom of end-organ dysfunction
- More than 2 of the following that occur rapidly after exposure to a likely allergen for the patient, including:
- Involvement of skin-mucosal tissue
- Respiratory involvement
- Reduced blood pressure or associated symptoms
- Gastrointestinal symptoms
- Reduced blood pressure as a result of exposure to a known allergen trigger 1
Testing for Venom-Specific IgE
Testing for venom-specific IgE antibodies is recommended for patients with a history of systemic reactions to insect stings, and can be performed using skin testing or in vitro testing 1.
- Skin testing with venom concentrations no stronger than 0.001 to 0.01 mg/mL is generally used, with a positive response at a concentration less than or equal to 1.0 mg/mL demonstrating the presence of specific IgE antibodies
- In vitro testing for IgE antibodies may be considered for patients with negative skin test responses, especially if they experienced serious symptoms such as upper airway obstruction or hypotension
Importance of Clinical History
A careful and complete review of the patient's clinical history is essential in diagnosing anaphylaxis, including the nature of the symptoms, the presence of cutaneous manifestations, airway obstruction, gastrointestinal symptoms, syncope, and hypotension 1.
- The history should concentrate on agents encountered before the reaction, and should be obtained from the patient, family members, or other witnesses whenever possible.
From the Research
Diagnostic Criteria for Anaphylaxis
The diagnostic criteria for confirming anaphylaxis caused by bee venom are not explicitly stated in the provided studies. However, some studies provide information on the diagnosis of anaphylaxis in general:
- The National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network (NIAID/FAAN) proposes three-item diagnostic criteria for anaphylaxis, which include acute onset of symptoms, involvement of multiple organ systems, and one or more of the following: symptoms of anaphylaxis after exposure to a known allergen, a decrease in blood pressure, or a history of anaphylaxis with similar symptoms 2.
- The World Allergy Organization (WAO) also has diagnostic criteria for anaphylaxis, which include acute onset of symptoms, involvement of multiple organ systems, and one or more of the following: symptoms of anaphylaxis after exposure to a known allergen, a decrease in blood pressure, or a history of anaphylaxis with similar symptoms 2.
Anaphylaxis Caused by Bee Venom
Some studies provide information on anaphylaxis caused by bee venom:
- A study found that bee venom anaphylaxis can be life-threatening and requires treatment with bee venom immunotherapy (bVIT) 3.
- Another study reported a fatal case of anaphylaxis caused by massive honey bee stings, highlighting the importance of prompt treatment and the potential for severe outcomes 4.
- A study also found that patients with bee venom allergy may be at risk of anaphylaxis from consuming bee products, such as honey or propolis, due to cross-reactivity between bee components and bee venom 5.
Treatment and Management
Some studies provide information on the treatment and management of anaphylaxis caused by bee venom:
- A study found that administration of adrenaline was effective in treating anaphylaxis caused by bee venom, especially in patients with angioedema and bronchospasm 2.
- Another study found that passive antibody therapy, using gamma-globulin obtained from hyperimmune beekeepers, was effective in preventing anaphylaxis in patients allergic to bee venom 6.