Bee and Vespula Venom Allergy Throughout the Stages of Life

The individual risk of anaphylactic sting reactions does not remain constant over the course of human life, but is dependent on age and state of health, personal activities and preferences. Moreover, personal circumstances and comorbidities may impair the diagnosis and treatment of Hymenoptera venom allergy. This review article aims to give an overview on the risks and specific characteristics of venom allergic patients throughout the stages of life. Severe sting-induced reactions are uncommon in children and adolescents despite a frequent exposure to stinging insects. Anaphylactic side effects of venom immunotherapy in children are as frequent as in adults but usually respond well to antiallergic treatment. A well-tolerated ongoing venom immunotherapy should be continued during pregnancy, because the risk of treatment-associated side effects is considered to be lower than the risk of a severe sting reaction following premature determination of treatment. Both occupational and recreational exposure to Hymenoptera stings may contribute to an increased frequency of anaphylactic sting reactions. The risk of severe and fatal reactions is increased in concurrent indolent systemic mastocytosis, but also in old age and possibly in coexistent cardiac comorbidities. Anti-hypertensive medication with beta-blockers and/or ACE inhibitors does not increase the risk of anaphylactic adverse effects during venom immunotherapy. Concerns regarding the safety and effectivity of venom immunotherapy in patients with coexisting malignancy or autoimmune diseases are not supported by clinical evidence. Treatment guidelines recommend venom immunotherapy for patients with sufficiently controlled autoimmune disorders or malignancies in stable remission.