Background: Venom immunotherapy is highly efficacious in preventing anaphylactic sting reactions. However, there is an ongoing discussion regarding patient selection and whether and how to apply a cost-benefit analysis of venom immunotherapy. In order to help decision-making, we investigated the re-sting frequency of hymenoptera-venom-allergic patients to single out those at high risk. Methods: In this retrospective study, re-sting data of 96 bee-venom-allergic patients and 95 vespid-venom-allergic patients living mainly in a rural area of Switzerland were analyzed. Hymenoptera venom allergy status was rated according to the classification system of H.L. Mueller [J Asthma Res 1966;3:331–333]. Different risk-groups were defined according to sting exposure and their median sting-free interval was calculated. Results: The risk factors for a wasp or bee re-sting were outdoor occupation, beekeeping and habitation close to a bee-house. Half of all vespid-venom-allergic outdoor workers were re-stung within 3.75 years compared to 7.5 years for indoor workers. Similarly, 50% of the bee-venom-allergic beekeepers or subjects with a bee-house in the vicinity suffered a bee re-sting within 5.25 years compared to 10.75 years for individuals who were not beekeepers. Conclusions: The high degree of exposure of vespid-venom-allergic outdoor workers and bee-venom-allergic beekeepers and subjects living close to bee-houses underlines the high benefit of venom immunotherapy for these patients even if they suffered a non-life-threatening grade II reaction. Yet, bee-venom-allergic individuals with no proximity to bee-houses and with an indoor occupation face a very low exposure risk, which justifies epinephrine rescue treatment for these patients especially if they have suffered from grade II sting reactions.

Biló BM, Bonifazi F: Epidemiology of insect-venom anaphylaxis. Curr Opin Allergy Clin Immunol 2008;8:330–337.
Moffitt JE, Golden DB, Reisman RE, Lee R, Nicklas R, Freeman T, Deshazo R, Tracy J, Bernstein IL, Blessing-Moore J, Khan DA, Lang DM, Portnoy JM, Schuller DE, Spector SL, Tilles SA: Stinging insect hypersensitivity: a practice parameter update. J Allergy Clin Immunol 2004;114:869–886.
Bonifazi F, Jutel M, Biló BM, Birnbaum J, Müller U: Prevention and treatment of hymenoptera venom allergy: guidelines for clinical practice. Allergy 2005;60:1459–1470.
Demain JG, Minaei AA, Tracy JM: Anaphylaxis and insect allergy. Curr Opin Allergy Clin Immunol 2010;10:318–322.
Ross RN, Nelson HS, Finegold I: Effectiveness of specific immunotherapy in the treatment of hymenoptera venom hypersensitivity: a meta-analysis. Clin Ther 2000;22:351–358.
Przybilla B, Rueff F, Walker A, Räwer HC, Aberer W, Bauer CP, Berdel D, Biedermann T, Brockow K, Forster J, Fuchs T, Hamelmann E, Jakob T, Jarisch R, Merk HF, Müller U, Ott H, Sitter W, Urbanek R, Wedi B: Diagnose und Therapie der Bienen und Wespengiftallergie. Allergo J 2011;20:318.
Oude Elberink JN, De Monchy JG, Van Der Heide S, Guyatt GH, Dubois AE: Venom immunotherapy improves health-related quality of life in patients allergic to yellow jacket venom. J Allergy Clin Immunol 2002;110:174–182.
Oude Elberink JN, Dubois AE: Quality of life in insect venom allergic patients. Curr Opin Allergy Clin Immunol 2003;3:287–293.
Przybilla B, Ruëff F: Hymenoptera venom allergy. J Dtsch Dermatol Ges 2010;8:114–127.
Mosbech H, Müller U: Side-effects of insect venom immunotherapy: results from an EAACI multicenter study. European Academy of Allergology and Clinical Immunology. Allergy 2000;55:1005–1010.
More DR, Hagan LL: Factors affecting compliance with allergen immunotherapy at a military medical center. Ann Allergy Asthma Immunol 2002;88:391–394.
Haye R, Dosen LK: Insect sting allergy. A study from 1980 to 2003 of patients who started treatment with venom immunotherapy between 1980 and 1998. Clin Mol Allergy 2005;3:12.
Müller UR: Hymenoptera venom hypersensitivity: an update. Clin Exp Allergy 1998;28:4–6.
Finegold I: Issues in stinging insect allergy immunotherapy: a review. Curr Opin Allergy Clin Immunol 2008;8:343–347.
Mueller HL: Diagnosis and treatment of insect sensitivity. J Asthma Res 1966;3:331–333.
Krishna MT, Ewan PW, Diwakar L, Durham SR, Frew AJ, Leech SC, Nasser SM: Diagnosis and management of hymenoptera venom allergy: British Society for Allergy and Clinical Immunology (BSACI) guidelines. Clin Exp Allergy 2011;41:1201–1220.
Golden DB: Insect sting allergy and venom immunotherapy: a model and a mystery. J Allergy Clin Immunol 2005;115:439–447.
Müller UR: Insect Sting Allergy. Stuttgart, Gustav Fischer, 1990.
Biló BM, Ruëff F, Mosbech H, Bonifazi F, Oude-Elberink JN: Diagnosis of hymenoptera venom allergy. Allergy 2005;60:1339–1349.
Pérez-Pimiento A, Prieto-Lastra L, Rodríguez-Cabreros M, Reaño-Martos M, García-Cubero A, García-Loria J: Work-related anaphylaxis to wasp sting. Occup Med 2007;57:602–604.
Bonadonna P, Schiappoli M, Dama A, Olivieri M, Perbellini L, Senna G, Passalacqua G: Is hymenoptera venom allergy an occupational disease? Occup Environ Med 2008;65:217–218.
Ruëff F, Chatelain R, Przybilla B: Management of occupational hymenoptera allergy. Curr Opin Allergy Clin Immunol 2011;11:69–74.
Müller UR: Bee venom allergy in beekeepers and their family members. Curr Opin Allergy Clin Immunol 2005;5:343–347.
Oude Elberink JN, van der Heide S, Guyatt GH, Dubois AE: Analysis of the burden of treatment in patients receiving an epipen for yellow jacket anaphylaxis. J Allergy Clin Immunol 2006;118:699–704.
Biló MB, Bonifazi F: The natural history and epidemiology of insect venom allergy: clinical implications. Clin Exp Allergy 2009;39:1467–1476.
Ruëff F, Przybilla B, Biló MB, Müller U, Scheipl F, Aberer W, Birnbaum J, Bodzenta-Lukaszyk A, Bonifazi F, Bucher C, Campi P, Darsow U, Egger C, Haeberli G, Hawranek T, Korner M, Kucharewicz I, Kuchenhoff H, Lang R, Quercia O, Reider N, Severino M, Sticherling M, Sturm GJ, Wüthrich B: Predictors of severe systemic anaphylactic reactions in patients with hymenoptera venom allergy: importance of baseline serum tryptase-A study of the European Academy of Allergology and Clinical Immunology Interest Group on Insect Venom Hypersensitivity. J Allergy Clin Immunol 2009;124:1047–1054.
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