Hymenoptera venom allergy in humans.

Reactions to Hymenoptera stings may appear as local or systemic responses. According to European data, the incidence of systemic reactions to Hymenoptera stings in the general population is 0.3-7.5%, with the value being 0.3-0.8% in children and 14-43% in beekeepers. The most common systemic allergic (anaphylactic) reactions are caused by honeybees (Apis mellifera), and certain species of wasps in the family Vespidae. Severe generalized immediate-type allergic (anaphylactic) reactions to insect stings are of the highest clinical importance. They affect skin, gastrointestinal tract, respiratory and cardiovascular system. The classification of severity of anaphylactic reaction following insect stings is based on the 4-grade Mueller scale. Crucial in patomechanism of anaphylaxis are specific IgE antibodies directed against the components of the venom, which mediate the activation of mast cells, the main effector cells of anaphylaxis. Therapeutic management in insect venom allergy should be considered in the context of prophylaxis, intervention in case symptoms develop, prevention in the form of venom specific immunotherapy (VIT). There are two steps of VIT 1. Initial dose venom immunotherapy (given according to four protocols which differ the time to reach the maintenance dose) 2. Maintenance dose VIT, usually equal 100 µg. Standard treatment time should span 3-5 years. The main mechanisms of immune tolerance that are initiated by VIT are associated with: 1. a decreased reactivity of effector cells, 2. expansion of T regulatory lymphocytes with IL-10 expression. Therapeutic effectiveness amounts to 90-100% in wasp venom allergy and approximately 80% in bee venom allergy.