D3.425 - Anaphylactic reaction to carpenter bee
Background
Hymenoptera allergy represents one of the major causes of anaphylactic allergic reactions. The hymenoptera most responsible for these reactions include bees (Apis mellifera and Bombus terrestris) and vespids (including the most frequent in Europe Vespula germanica, Polistes dominulus and V.crabro).
In recent years, lesser-known hymenoptera have been described as the cause of local and systemic reactions, including the carpenter bee (Xylocopa), a solitary aculeate bee with a smooth sting that is used to nest in wood.
Method
We present the case of a 71-year-old man with a systemic reaction to a carpenter bee sting (recognises the carpenter bee as the stinging insect) while carrying out work in the countryside. A few minutes after the sting, visual blurring and generalised itching appeared. On arrival at the 118 emergency services, hypotension (BP 85/50 mmhg) was detected: he was treated with antihistamines, systemic steroids and adrenaline by i.m. with improvement of symptoms. Previously reported vespid and bee stings with only normal local reaction.
Results
Skin tests were carried out with hymenoptera venom positive for bees (intradermal reaction up to 1mcg/ml) and positive for vespids (vespula species,polistes dominula, vespa crabro) (intradermal reaction up to 1mcg/ml). Blood tests showed normal total IgE and tryptase, positive IGE for bee, vespula, polistes and v.crabro as proof of the multiple stings reported by the patient.
Conclusion
The patient was prescribed emergency therapy with antihistamine, steroid and adrenaline auto-injector. Given the cross-reactivity demonstrated in the literature between carpenter bee venom and honey bee venom, we prescribed honey bee-specific immunotherapy.No local or systemic reactions occurred in the induction phase, and the patient has not presented with any further bee stings since the start of immunotherapy. We therefore hypothesise that in the case of a systemic reaction to carpenter bee (Xylocopa violacea) the same diagnostic-therapeutic procedure can be followed as for patients allergic to honey bee.
