Clinical Features of Patients with Bee Stings Anaphylaxis and the Related Risk Factors_West China Medical Journal

Authors：

 YAORong ¹ , NIFen ² , HUHai ¹ , DUMin ¹ , XUShu-yun ¹ ,  CAOYu ¹

1. Emergency Department, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Emergency Department, Qingdao Municipal Hospital, Qingdao, Shandong 266000, P. R. China;

Corresponding author：

CAOYu, Email: dr.yu.cao@gmail.com

Keywords：

Bee stings; Anaphylaxis; Epidemiology; Risk factors; Prognosis

DOI：

10.7507/1002-0179.20150293

Video：

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Objective To identify the clinical features of and risk factors for allergic reaction to bee stings in Sichuan. Method We retrospectively analyzed the clinical data of 387 patients with bee stings admitted to the Emergency Department of nine hospitals in Sichuan during January 1, 2010 to December 31, 2011, and evaluated the risk factors for bee sting anaphylaxis with logistic regression analysis, and explored the influence of anaphylaxis on death with Fisher exact probability method. Results Among the 387 patients with bee stings, 41 (10.6%) had allergic reactions. The age in patients from the anaphylaxis group was significantly older than those in the non-anaphylaxis group (P<0.05). Logistic regression analysis showed that age was an independent risk factor for allergic reaction in patients with bee stings[OR=0.983, 95%CI (0.967, 0.999), P=0.042]. All the patients with allergic reactions were prescribed with systemic corticosteroids, and 16 were prescribed with antihistamine drugs, but no patients were prescribed with epinephrine. Among the 16 patients with systemic allergic reaction, 12 were given less than 1000 mL intravenous rehydration per 24 h, 2 were given 1000-3000 mL intravenous rehydration, and only 2 were given more than 3 000 mL intravenous rehydration. The mortality of allergic patients was significantly higher than that of the non-allergic group (9.8% vs 1.4%, P<0.05). Conclusions The mortality of anaphylaxis patients is significantly higher than that of the non-anaphylaxis group. Age is an independent risk factor for allergic reactions to bee stings. Treatment of bee stings related to severe allergic reaction needs to be further standardized.

Citation： YAORong, NIFen, HUHai, DUMin, XUShu-yun, CAOYu. Clinical Features of Patients with Bee Stings Anaphylaxis and the Related Risk Factors. West China Medical Journal, 2015, 30(6): 1019-1022. doi: 10.7507/1002-0179.20150293 Copy

1.	Ben-Shoshan M, Clarke AE. Anaphylaxis:past, present and future[J]. Allergy, 2011, 66(1):1-14.
2.	Simons FE, Ardusso LR, Dimov V, et al. World allergy organization anaphylaxis guidelines:2013 update of the evidence base[J]. Int Arch Allergy Immunol, 2013, 162(3):193-204.
3.	Matysiak J, Matysiak J, Bręborowicz A, et al. Diagnosis of hymenoptera venom allergy-with special emphasis on honeybee (Apis mellifera) venom allergy[J]. Ann Agric Environ Med, 2013, 20(4):875-879.
4.	Ma L, Danoff TM, Borish L. Case fatality and population mortality associated with anaphylaxis in the United States[J]. J Allergy Clin Immunol, 2014, 133(4):1075-1083.
5.	Brown TC, Tankersley MS. The Sting of the honeybee:an allergic perspective[J]. Ann Allergy Asthma Immunol, 2011, 107(6):463-470.
6.	Biló BM, Rueff F, Mosbech H, et al. Diagnosis of hymenoptera venom allergy[J]. Allergy, 2005, 60(11):1339-1349.
7.	Bilò MB. Anaphylaxis caused by Hymenoptera stings:from epidemiology to treatment[J]. Allergy, 2011, 66(Suppl 95):35-37.
8.	Steen CJ, Janniger CK, Schutzer SE, et al. Insect Sting reactions to bees, wasps, and ants[J]. Int J Dermatol, 2005, 44(2):91-94.
9.	Tejedor Alonso MA, Moro Moro M, Múgica García MV. Epidemiology of anaphylaxis[J]. Clin Exp Allergy, 2015, 5(6):1027-1039.
10.	Hamilton RG. Diagnosis and treatment of allergy to hymenoptera venoms[J]. Curr Opin Allergy Clin Immunol, 2010, 10(4):323-329.
11.	Fitzgerald KT, Flood AA. Hymenoptera stings[J]. Clin Tech Small Anim Pract, 2006, 21(4):194-204.
12.	Lieberman P, Nicklas RA, Oppenheimer J, et al. The diagnosis and management of anaphylaxis practice parameter:2010 Update[J]. J Allergy Clin Immunol, 2010, 126(3):477-480. e42.
13.	Antonicelli A, Bilò MB, Bonifazi F. Epidemiology of hymenoptera allergy[J]. Curr Opin Allergy Clin Immunol, 2002, 2(4):341-346.
14.	Muraro A, Roberts G, Worm M, et al. Anaphylaxis:guidelines from the European Academy of Allergy and Clinical Immunology[J]. Allergy, 2014, 69(8):1026-1045.
15.	Haye R, Døsen LK. Insect sting allergy. A study from 1980 to 2003 of patients who started treatment with venom immunotherapy between 1980 and 1998[J]. Clin Mol Allergy, 2005, 3:12.
16.	倪芬, 姚蓉, 曹钰. 四川省蜂蜇伤诊治现状调查及预后影响因素的分析[J]. 中华急诊医学杂志, 2013, 22(3):295-298.
17.	Gelincik A, İşsever H, Unal D, et al. The prevalence of Hymenoptera venom allergy in adults:the results of a very crowded city in Euroasia[J]. Allergol Int, 2015, 64(1):35-40.
18.	四川省急诊医学专委会中毒与复苏学组. 四川省蜂螫伤规范化诊治专家共识[J]. 华西医学, 2013, 28(9):1325-1328.
19.	Lee JK, Vadas P. Anaphylaxis:mechanisms and management[J]. Clin Exp Allergy, 2011, 41(7):923-938.

1. Ben-Shoshan M, Clarke AE. Anaphylaxis:past, present and future[J]. Allergy, 2011, 66(1):1-14.
2. Simons FE, Ardusso LR, Dimov V, et al. World allergy organization anaphylaxis guidelines:2013 update of the evidence base[J]. Int Arch Allergy Immunol, 2013, 162(3):193-204.
3. Matysiak J, Matysiak J, Bręborowicz A, et al. Diagnosis of hymenoptera venom allergy-with special emphasis on honeybee (Apis mellifera) venom allergy[J]. Ann Agric Environ Med, 2013, 20(4):875-879.
4. Ma L, Danoff TM, Borish L. Case fatality and population mortality associated with anaphylaxis in the United States[J]. J Allergy Clin Immunol, 2014, 133(4):1075-1083.
5. Brown TC, Tankersley MS. The Sting of the honeybee:an allergic perspective[J]. Ann Allergy Asthma Immunol, 2011, 107(6):463-470.
6. Biló BM, Rueff F, Mosbech H, et al. Diagnosis of hymenoptera venom allergy[J]. Allergy, 2005, 60(11):1339-1349.
7. Bilò MB. Anaphylaxis caused by Hymenoptera stings:from epidemiology to treatment[J]. Allergy, 2011, 66(Suppl 95):35-37.
8. Steen CJ, Janniger CK, Schutzer SE, et al. Insect Sting reactions to bees, wasps, and ants[J]. Int J Dermatol, 2005, 44(2):91-94.
9. Tejedor Alonso MA, Moro Moro M, Múgica García MV. Epidemiology of anaphylaxis[J]. Clin Exp Allergy, 2015, 5(6):1027-1039.
10. Hamilton RG. Diagnosis and treatment of allergy to hymenoptera venoms[J]. Curr Opin Allergy Clin Immunol, 2010, 10(4):323-329.
11. Fitzgerald KT, Flood AA. Hymenoptera stings[J]. Clin Tech Small Anim Pract, 2006, 21(4):194-204.
12. Lieberman P, Nicklas RA, Oppenheimer J, et al. The diagnosis and management of anaphylaxis practice parameter:2010 Update[J]. J Allergy Clin Immunol, 2010, 126(3):477-480. e42.
13. Antonicelli A, Bilò MB, Bonifazi F. Epidemiology of hymenoptera allergy[J]. Curr Opin Allergy Clin Immunol, 2002, 2(4):341-346.
14. Muraro A, Roberts G, Worm M, et al. Anaphylaxis:guidelines from the European Academy of Allergy and Clinical Immunology[J]. Allergy, 2014, 69(8):1026-1045.
15. Haye R, Døsen LK. Insect sting allergy. A study from 1980 to 2003 of patients who started treatment with venom immunotherapy between 1980 and 1998[J]. Clin Mol Allergy, 2005, 3:12.
16. 倪芬, 姚蓉, 曹钰. 四川省蜂蜇伤诊治现状调查及预后影响因素的分析[J]. 中华急诊医学杂志, 2013, 22(3):295-298.
17. Gelincik A, İşsever H, Unal D, et al. The prevalence of Hymenoptera venom allergy in adults:the results of a very crowded city in Euroasia[J]. Allergol Int, 2015, 64(1):35-40.
18. 四川省急诊医学专委会中毒与复苏学组. 四川省蜂螫伤规范化诊治专家共识[J]. 华西医学, 2013, 28(9):1325-1328.
19. Lee JK, Vadas P. Anaphylaxis:mechanisms and management[J]. Clin Exp Allergy, 2011, 41(7):923-938.

West China Medical Journal

Clinical Features of Patients with Bee Stings Anaphylaxis and the Related Risk Factors

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