D2.164 - Pediatric bee venom allergy: family background matters
Case report
Children experience less severe reactions compared to adults. However, the families of beekeepers are at greater risk of reactions due to bee stings. We present 3 pediatric cases from beekeeping families who experienced anaphylaxis following bee stings.
The 1st case corresponds to a 13-year-old adolescent with non-allergic rhinoconjunctivitis, whose grandfather is a beekeeper. At the age of 6, he was stung in the forehead at the grandparents’ house, presenting with facial angioedema, prostration and emesis. He was treated with IV clemastine and dexamethasone. Diagnostic workup revealed a total IgE of 200 kU/L, specific IgE (sIgE) for honey bee venom (HBV) of 45.1 kU/L and normal baseline tryptase (6.24 μg/L). Intradermal tests (IDT) with HBV were positive at 0.1 µg/mL. He underwent 5 years of specific venom immunotherapy (VIT) and tolerated a field sting 2 years after starting VIT.
The 2nd case concerns a 6-year-old-boy, allergic to kiwi. His father is a beekeeper, allergic to HBV. At the age of 4, he was stung in the forehead while near family members handling beekeeping tools, presenting with facial angioedema, generalized exanthema and syncope. He was treated with IM adrenaline, IV clemastine and methylprednisolone. Lab results showed a total IgE of 247 kU/L, HBV sIgE of 18.4 kU/L, and normal baseline tryptase (2.94 μg/L). At the age of 4, the boy and his father also initiated VIT, which is still ongoing. The boy was re-stung 4 months after without any reaction.
The 3rd case involves a 11-year-old boy, the son and nephew of beekeepers. After being stung on the forehead near the apiary, he presented with cough, generalized exanthema, facial angioedema, hypotension and desaturation. He was treated with IM adrenaline, IV hydrocortisone and cetirizine. Diagnostic workup showed total IgE of 203 kU/L, HBV sIgE of 87.20 kU/L, normal tryptase (5.69 μg/L), and positive IDT at 0.01 µg/mL. VIT will be soon initiated.
Children whose family members are beekeepers are at a higher risk of exposure to bee stings and HBV allergy. Venom allergy is not expected to be outgrown and VIT is an effective treatment in patients with systemic allergic reactions, regardless of age. This is supported by the observed outcomes in the first patients, who were re-stung without experiencing any systemic reactions. The 2nd patient began VIT before the age of 5, highlighting that this treatment is effective even at such an early age.
