Epidemiology of Insect Venom Allergy

Insect venom allergy is among the classic IgE-mediated diseases, in Germany it is mostly mediated by compounds of the venoms of the honeybee (Apis mellifera) or vespid species ( Vespula germanica or V. vulgaris). Potentially, insect venom allergy manifests in severe and lethal reactions. The prevalence of insect venom allergy depends on exposure. More than half of the general population receives at least one Hymenoptera sting during their lives, estimates range from 57% for Italy to 95% for Turkey. There are few population-based studies which measured mostly by the detection of allergen-specific IgE antibodies the prevalence of venom sensitization. According to international investigations 9-18% of the adult population are sensitized. In a study of258 subjects in rural Bavaria 27% exhibited IgE antibodies, the respective prevalence in 821 inhabitants of the city of Hamburg was 25%. Reports on systemic reactions due to insect stings indicate that between 0.3% to 3.3% of the general population are affected. The latter figure resulted from the Bavarian study, in Hamburg the corresponding figure was 1.8%. The international comparison reveals a North-South gradient, males and elderly people are affected more frequently. Lately concomitant mastocytosis (including occult forms) and elevated baseline serum tryptase levels were identified as relevant risk factors for severe reactions. Patients with elevated tryptase levels more often showed severe reactions than those without elevated levels (75% vs. 28%). Internationally, the mortality is estimated to be in a range between 0.03 (Italy) and 0.48 (France) per 1,000,000 inhabitants and year. Age (> 40 years), sex (male), comorbidities, sting location (head,