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Age-dependent sting recurrence and outcome in immunotherapy-treated children with anaphylaxis to Hymenoptera venom

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Published:25th Mar 2020
Background: Data on outcome of insect venom immunotherapy in children are rare. Objective: We investigated the rate of sting recurrence and outcome of Hymenoptera venom anaphylaxis in children of different age groups treated with immunotherapy. Methods: Data from children consecutively referred for anaphylaxis to Hymenoptera venom were collected using a standardized questionnaire. Results: During mean follow-up of 7.7 years after commencement of immunotherapy, 45 of 83 children (56%) were re-stung 108 times by the insect they were allergic to. This corresponds to a rate of 0.23 stings per child and year of follow-up. The younger the subject, the higher was the prevalence of re-stings, with rates of 0.41 in children <6 years, 0.21 at school age and 0.15 in adolescents (p="0.001)." in contrast, prevalence of systemic allergic reactions to field stings was significantly lower in preschool (3.4%) and school-age children (4.3%) compared to adolescents (15.6%; p><0.05). overall, prevalence of systemic allergic reactions at re-sting was 15.6% in the honey bee venom and 5.9% in the vespula venom allergic group (p="ns)." younger boys with anaphylaxis to honey bee venom predominated in our cohort (p="0.019)." conclusion & clinical relevance: a majority of children with anaphylaxis to hymenoptera venom (56%) in our cohort were re-stung, equally by honey bees or vespula species. younger children were more likely to be re-stung but less likely to have a systemic reaction. venom immunotherapy induces long-term protection in most children: 84.4% of subjects with anaphylaxis to honey bee and 94.1% of those to vspula venom were completely protected at re-stings.>

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