D2.209 - 'Which bee was it?': A literature review of Honeybee Venom Immunotherapy used in paediatric patients stung by different bee subspecies

Honeybee Venom Immunotherapy (VIT) has been used to successfully prevent severe reactions in both adult and paediatric patients in subsequent exposure to bee stings. However, bee subspecies vary globally in terms of geographical distribution and behaviour. This literature review was conducted to explore differences between 3 common bee subspecies and use of standard Honeybee VIT in children with different exposure history.

Online literature search was carried out, using platforms including Medline Ovid and PubMed. Papers were selected based on mention of paediatric VIT and three bee subspecies: 1. Apis mellifera (European Honeybee) 2. Apis m. scutellata(East African lowland honeybee or Original African Honeybee) 3. Hybrid Apis m. scutellata x Apis mellifera (Africanised 'Killer' bee). 

In Europe and the UK, standard Honeybee VIT (depot or aqueous extract preparations) is used in eligible children with severe systemic reactions and some large localised reactions with additional risk factors, as per EAACI Venom Immunotherapy (2019) and BSACI Venom Immunotherapy (2011) guidelines. Studies show that using the same Honeybee VIT, derived from the European Honeybee venom is effective against the African Honeybee and the Africanised Killer bee hybrid. This is due to similarity of the venom composition between the three subspecies, with only small variation in the amounts of the components: phospholipase A2 (Api m 1), hyaluronidase (Api m 2), and melittin (Api m 4). The main difference between the EU Honeybee and the African Honeybee and the hybrid ‘Killer’ bee variant, is the more aggressive behaviour in defending their hives in the latter two. Therefore, risk of being stung more times and more severe reactions are more likely in Africa, Central and South America. 

Standard Honeybee VIT is effective against the three subspecies explored in this literature review. This may provide reassurance for children and their families with higher risk of exposure to bees, or visiting areas where other subspecies are more prevalent compared to their homeland. Adrenaline Auto-injectors and exposure avoidance are still necessary precautions.