Bee Venom Immunotherapy

Bee sting sensitivity can result in death. Sensitivity can occur at any age. Reactions that are life-threatening include bee stings that are associated with difficulty breathing (wheezing, shortness of breath) or a drop in blood pressure (fainting, extreme weakness, seizures). Desensitization for 3-5 years is permanently protective in virtually all cases.

Large local swelling, restricted to the site of the sting, is not generally associated with a significant risk for future severe reaction.

If a patient has had a bee sting complicated by hives, breathing difficulties, throat closure, or symptoms related to hypotension, then an appointment needs to be made for bee sting testing. The appointment is scheduled 4 weeks after the last bee sting. If the patient is less than 12 years old and the adverse reaction was hives only, desensitization is not recommended and skin testing is usually not performed.

It has been demonstrated in laboratory testing that patients who suffer severe allergic reactions to bee stings (wasps, hornets, honey bees) have a 40-50% chance that the next sting from a similar species will also be as severe or even worse than the prior reaction. Therefore, venom testing is recommended for all patients who have an allergic reaction complicated by difficulty breathing or shock. Additionally, if over 12 years of age, the occurrence of hives may also signal a potential worsening of symptoms with subsequent stings. These individuals are also included in the group in whom venom immunotherapy (bee-sting shots) is recommended. Individuals under 12 years of age who have had only hives, are not considered at risk for future severe allergic problems at a rate any higher than that of the general population, which is thought to be somewhere from 0.5-2%.

How long should venom immunotherapy be continued? Unfortunately, we are not entirely certain of a recommendation that would be 100% correct for every individual, but several guidelines are available. These recommendations are derived as a consensus from the best known experts in the field, and are as follows:

    Repeat skin testing 3 years after institution of venom immunotherapy. If the skin tests are entirely negative, then immunotherapy should be discontinued.

    If repeat skin tests are positive after 3 years of treatment, then immunotherapy should be continued for a full 5 years, then discontinued without additional skin testing. It is estimated that a bee sting occurring after 5 years of venom immunotherapy will result in a reaction only 10% of the time, and it is virtually always minor.

    However, patients with severely compromised hearts or lungs should probably continue venom immunotherapy for an undefined period of time, since they are the most likely to have difficulty handling reactions, even relatively mild ones if they involve the heart or lungs.

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	Repeat skin testing 3 years after institution of venom immunotherapy. If the skin tests are entirely negative, then immunotherapy should be discontinued.
	If repeat skin tests are positive after 3 years of treatment, then immunotherapy should be continued for a full 5 years, then discontinued without additional skin testing. It is estimated that a bee sting occurring after 5 years of venom immunotherapy will result in a reaction only 10% of the time, and it is virtually always minor.
	However, patients with severely compromised hearts or lungs should probably continue venom immunotherapy for an undefined period of time, since they are the most likely to have difficulty handling reactions, even relatively mild ones if they involve the heart or lungs.