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Hymenoptera stings


Essentials

  • 1

    Hymenoptera strings are responsible for one or two deaths annually in Australia.

  • 2

    Hymenoptera venom is a common cause of allergy and anaphylaxis (∼3% of population).

  • 3

    Anaphylaxis is an absolute indication for venom immunotherapy.

  • 4

    Massive envenomation by bees and wasps can cause multi-organ involvement and death, although this is rare.

  • 5

    Mass envenomation does not appear to result from ant stings.

Introduction

Hymenoptera, an order of insects, comprise some 35,000 species. Clinical effects occur from exposure to stings from the families Apidae (bees), Vespidae (wasps, yellowjackets/European wasps) and Formicidae (ants).

Local irritation, allergy and anaphylaxis are common to all members of the group, with stinging events accounting for up to 35% of all cases of anaphylaxis reported annually. About 3% of people stung develop anaphylaxis.

Hymenoptera constitute a major threat to public health. In Australia they are responsible for as many deaths (average 2 yearly) and twice as many hospital presentations as our much more feared snakes. Despite this, most species of bees and wasps are solitary creatures and rarely sting humans.

Bee stings

The European honeybee (Apis mellifera) is the most common cause of stings in Australia. Female bees sting only once, leaving their stings in place. The venom is complex, its main constituent being melittin (major cause of pain).

Clinical effects

These depend on the type of bee, prior exposure and the sensitivity of the victim.

  • Local pain and irritation

    • Usually minor, usually subsides after 1 to 2 hours, but may last up to 48 hours.

    • Approximately 10% of those stung will develop a large local reaction, peaking at 48 hours and lasting 5 to 10 days.

  • Anaphylaxis

    • IgE-mediated.

    • Almost always occurs within 30 minutes of the sting, with life-threatening anaphylaxis manifesting within minutes.

    • The reaction may be prolonged or recurrent, lasting up to 24 hours.

    • This is the most common cause of death from Hymenoptera stings.

  • Serum sickness (see Chapter 2.8).

  • Mass envenomation (see further on).

  • Death.

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