A longitudinal study of hymenoptera stings in preschool children

• Published in: Pediatric allergy and immunology Vol. 30; no. 1; pp. 93 - 98
• Main Authors: Clifford, Danielle, Ni Chaoimh, Carol, Stanley, Eve, O’B Hourihane, Jonathan, Ebisawa, Motohiro
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-02-2019
• Subjects: Allergies; Anaphylaxis; Animals; Child, Preschool; Children; Cohort Studies; epidemiology; Female; Humans; hymenoptera; Hymenoptera - immunology; Hypersensitivity - epidemiology; Hypersensitivity - etiology; Immunoglobulin E; Immunoglobulin E - blood; Infant; Insect Bites and Stings - epidemiology; Insect Bites and Stings - immunology; Ireland - epidemiology; Longitudinal Studies; Male; pediatrics; Preschool children; Prospective Studies; Skin tests; Skin Tests - statistics & numerical data; sting allergy; Stings; Surveys and Questionnaires; Venom; Ireland; epidemiology; hymenoptera; pediatrics; sting allergy
• ISSN: 0905-6157; 1399-3038
• DOI: 10.1111/pai.12987

Background
Insect venom is the second most common cause of anaphylaxis outside of medical encounters. Stings cause over 20% of all anaphylactic deaths and 7% of anaphylaxis in children. To date, there have been no longitudinal studies of insect sting events or allergy in preschool children.
Methods
A prospective longitudinal nested observational study in the BASELINE Birth Cohort Study (n = 2137). Sting‐related questions were asked at 6 and 12 months and 2 and 5 years. Skin prick testing (SPT) was performed at 2 and 5 years. SpIgE testing was performed on selected cases at 2 years.
Results
Seventy‐seven children (6.8%) were stung by the age of 2. Of these, 25 (32.5%) reported adverse reactions (four systemic). Eleven (0.9%) had positive SPT at 2 years (eight bee, two wasp, one both). Four stung children had positive SPT. Two (one stung, one never stung) had positive spIgE to a venom component at 2 years. A total of 268 children (21.9%) were stung by 5 years, 144 (52.1%) reporting local reactions and none systemic. Four children (0.4%) had positive SPT at 5 years: one bee and three wasp. Of the 11 SPT‐positive children at 2 years, none were still positive at 5 years.
Conclusion
This is the first longitudinal study of the natural history of hymenoptera stings and allergy in preschool children. Hymenoptera venom allergy is less common in this cohort than in adults. Systemic reactions were not medically documented in this population, in keeping with previous literature. This study confirms the poor correlation of IgE sensitization to venom with sting allergy and does not support the common parental request to screen children for sting allergy.