Abstract
Insect venom allergy is the most frequent cause of anaphylaxis in Europe
and possibly worldwide. The majority of systemic allergic reactions
after insect stings are caused by Hymenoptera and among these, vespid
genera induce most of the systemic sting reactions (SSR). Honey bees are
the second leading cause of SSR. Depending on the global region, other
Hymenoptera such as different ant genera are responsible for SSR. Widely
distributed hornets and bumblebees or local vespid or bee genera rarely
induce SSR. Hematophagous insects such as mosquitoes and horse flies
usually cause (large) local reactions while SSR occasionally occur. This
position paper aims to identify either rare or locally important insects
causing SSR as well as rarely occurring SSR after stings or bites of
widely distributed insects. We summarized relevant venom or saliva
allergens and intended to identify possible cross-reactivities between
the insect allergens. Moreover, we aimed to locate diagnostic tests for
research and routine diagnosis, which are sometimes only regionally
available. Finally, we gathered information on disposable
immunotherapies. Major allergens of most insects were identified, and
cross-reactivity between insects was frequently observed. While some
diagnostics and immunotherapies are locally available, standardized skin
tests and immunotherapies are generally lacking in rare insect allergy.
Keywords: ants; arthropods; insects; saliva allergy; venom
allergy;
Introduction Insect venom allergy is the most frequent cause of anaphylaxis in
adults in Europe.1 The majority of systemic allergic
reactions after insect stings are caused by Hymenoptera and among these,
vespid genera induce most of the systemic sting reactions
(SSR).1 Vespid genera are usually found in regions
with temperate climate (Figure 1). Honey bees are cultivated insects and
distributed worldwide except in the polar regions. They are the second
leading cause of SSR.1 Other Hymenoptera such as
different ant genera are responsible for SSR mainly in Central and South
America, Africa, Asia, and Australia (Figure 2). Widely distributed
hornets (Figure 3) and bumblebees or local vespid or bee genera rarely
induce SSR. Hematophagous insects such as mosquitoes and horse flies
usually cause (large) local reactions while SSR occasionally occur.
Global warming, globalization, and human activity are responsible for
insect redistribution, increasing the number of allergy cases caused by
stinging insects worldwide.2
This position paper aims to identify either rare or locally important
insects leading to SSR as well as rarely occurring SSR after stings or
bites of widely distributed insects and other arthropods. We further
summarized relevant venom or saliva allergens and intended to identify
possible cross-reactivities between the arthropod allergens. Moreover,
we aimed to list diagnostic tests for research and routine diagnosis and
information on disposable immunotherapies.