Müller U
Medizinische Klinik, Zieglerspital Bern.
Schweiz Med Wochenschr. 1989 Dec 9;119(49):1761-8.
Systemic allergic reactions following insect stings, most often by hymenoptera (honey bee, wasp), are usually of the immediate type and thus mediated by venom specific IgE-antibodies. The most frequent clinical symptoms are urticaria, angioedema, asthma and anaphylactic shock. While in epidemiological surveys up to 4% of individuals report a history of systemic allergic reactions following hymenoptera stings, fatal cases are extremely rare. Diagnosis is based on history, skin tests and estimation of venom specific serum IgE-antibodies (RAST). For treatment of mild systemic reactions antihistamines are often sufficient. In all cases with respiratory and/or cardiovascular symptoms, adrenalin must be given either by inhalation or by injection. All patients with a history of systemic reactions to hymenoptera stings must be instructed in prophylactic measures and receive emergency medication including adrenalin. The efficacy of venom immunotherapy is well documented but this treatment is expensive. It is therefore mainly indicated in patients with a history of sever systemic reactions and a high degree of exposure.
昆虫叮咬后的全身过敏反应，最常见于膜翅目昆虫（蜜蜂、黄蜂）叮咬，通常属于速发型，由毒液特异性IgE抗体介导。最常见的临床症状是荨麻疹、血管性水肿、哮喘和过敏性休克。在流行病学调查中，高达4%的个体报告有膜翅目昆虫叮咬后全身过敏反应的病史，但致命病例极为罕见。诊断基于病史、皮肤试验和毒液特异性血清IgE抗体（放射性过敏原吸附试验）的测定。对于轻度全身反应的治疗，抗组胺药通常就足够了。在所有有呼吸道和/或心血管症状的病例中，必须通过吸入或注射给予肾上腺素。所有有膜翅目昆虫叮咬后全身反应病史的患者都必须接受预防措施指导，并接受包括肾上腺素在内的急救药物。毒液免疫疗法的疗效有充分记录，但这种治疗费用昂贵。因此，它主要适用于有严重全身反应病史且暴露程度高的患者。
