Although the majority of children outgrow allergies to
bee, wasp and other insect stings, almost one in five who
had allergic reactions when stung as children —
especially those who had serious reactions — are
likely to have reactions later in life, according to a
study by Johns Hopkins scientists.
Contrary to popular wisdom, a great number of children
do not outgrow allergic reactions to insect stings," said
David Golden, associate professor of
medicine in the
School of Medicine and lead author of a report on the
study appearing in the Aug. 12 issue of the New England
Journal of Medicine. "The good news is that for
children with moderate to severe reactions, allergy shots
will lower the risk of serious reactions to stings even 10
to 20 years after treatment is stopped."
Allergy shots, or venom immunotherapy, give purified
bee or other insect venom in small doses that build up over
time and are recommended for children who have moderate or
severe reactions, including dizziness, breathing difficulty
and lowered blood pressure. There is little need for the
therapy in children with milder reactions, such as minor
swelling and hives, Golden said.
Between 1978 and 1985, the researchers diagnosed
allergic reaction to insect stings in 1,033 children, 356
of whom subsequently received venom immunotherapy. To
determine how many children outgrow their allergies to
insect stings, the researchers collected follow-up
information on more than 500 of these children, 40 percent
of whom had received stings in the six to 32 years after
their first reaction.
The researchers conducted a survey of these patients
by telephone and mail between 1997 and 2000. Patients were
asked to describe their reactions and were provided with a
standard list of questions about symptoms, the length of
the reaction and how the reaction was treated.
Mild reactions affected only the skin and involved
hives and minor swelling. Moderate reactions included skin
reactions but also throat and chest discomfort, difficulty
breathing, dizziness and low blood pressure. Severe
reactions included skin reactions but also marked
difficulty breathing, severe dizziness and marked low blood
pressure or unconsciousness.
The researchers found that moderate and severe
reactions occurred less frequently in adults who had
received venom immunotherapy as children (3 percent) than
in those who had not (17 percent). Patients with a history
of moderate or severe reactions had a higher rate of
reaction if they had not been treated (32 percent) than if
they had received venom immunotherapy (5 percent). The
average duration of venom immunotherapy was three and a
half years. This report describes the longest-lasting
effects of allergen immunotherapy yet observed, Golden
said.
Other authors of the report are Lawrence Lichtenstein,
Robert Hamilton, Philip Norman and Anne Kagey-Sobotka, all
from Johns Hopkins. The study was supported by the National
Institutes of Health.
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