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Arnon Goldberg - One of the best experts on this subject based on the ideXlab platform.
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debilitating beliefs and emotional distress in patients given immunotherapy for Insect Sting allergy a prospective study
Allergy and Asthma Proceedings, 2009Co-Authors: Ronit Confinocohen, Samuel Melamed, Arnon GoldbergAbstract:Patients who receive venom immunotherapy (VIT) for systemic reactions (SRs) to Insect Stings are advised that once they reach the maintenance dose they are almost 100% protected against future SRs. However, initial evidence indicates that some patients continue to perceive themselves as highly debilitated by the allergy and are preoccupied with the allergic event. These factors have significant impact on their emotional well-being and allergy-related quality of life (ARQOL). We aimed to explore prospectively whether patients would experience these adverse psychological outcomes after receiving VIT coupled with professional explanation and reassurance of protection. Thirty-four patients who received VIT for systemic Insect allergy and were under close medical surveillance were included. Before and 1 year after initiation of treatment, patients completed a questionnaire that measured debilitating beliefs, preoccupation with the SR event, emotional distress ARQOL, and QOL in general. Physician-graded severity of the reaction was recorded as well. VIT had a beneficial effect on all allergy-related variables. Self-imposed debilitating beliefs, preoccupation with the anaphylactic event, and ARQOL significantly but modestly improved over time. No association was found between ARQOL and QOL in general. The later variable as well as emotional distress remained unchanged after the VIT. This study shows that patients with Sting allergy guided by trained personnel and treated with VIT show a reduction in dysfunctional beliefs and an improvement in ARQOL. Disputing medically unfounded beliefs that persist in some patients might improve their ARQOL.
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Reproducibility of skin teSting and serum venom specific IgE in Hymenoptera venom allergy.
Annals of Allergy Asthma & Immunology, 2006Co-Authors: Yael Graif, Ronit Confino-cohen, Arnon GoldbergAbstract:Background The decision regarding an immunotherapy regimen for venom-allergic patients is based on the results of skin teSting and serum venom specific IgE measurements. However, their reliability has been questioned, and their reproducibility has not been examined. Objective To evaluate the reproducibility and reliability of the results of skin teSting and serum venom specific IgE measurement in venom-allergic patients. Methods Patients with a systemic reaction after an Insect Sting were evaluated twice, 2 to 6 weeks apart, by intradermal skin tests and by determination of serum venom specific IgE to Hymenoptera venoms. Results Thirty-five patients were evaluated 1 to 168 months (mean, 23 months) after the Sting reaction. Reproducibility of skin test results for all venoms at the 2 sessions was found in 23 patients (66%). Reproducibility of venom specific IgE results for all venoms was found in 16 (59%) of 27 patients from whom 2 blood samples were available for evaluation. Concordance between skin test and venom specific IgE results for all venoms was found in 30 (51%) of 59 samples available for evaluation. Conclusions The reproducibility of venom skin test and serum venom specific IgE results is relatively poor. It is common practice for therapeutic decisions regarding venom immunotherapy to be based on a single diagnostic evaluation. Consequently, many patients are either overtreated or undertreated. Better diagnostic methods are required in venom allergy.
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Insect Sting inflicted systemic reactions attitudes of patients with Insect venom allergy regarding after Sting behavior and proper administration of epinephrine
The Journal of Allergy and Clinical Immunology, 2000Co-Authors: Arnon Goldberg, Ronit ConfinocohenAbstract:Abstract Background: Patients with Insect venom allergy are at higher risk for development of a recurrent systemic reaction after re-Sting. This risk significantly decreases with venom immunotherapy. Patients with Insect venom allergy should be able to diStinguish a life-threatening systemic reaction from all other various reactions after an Insect Sting. Accidental epinephrine injection by EpiPen has been reported in the past. Therefore patients with venom allergy should also be well trained in self-administration of their epinephrine when needed. Objective: Our objective was to assess patients' attitudes regarding after-Sting behavior and their capability to correctly self-administer the epinephrine autoinjector. Methods: All patients with venom allergy attending our allergy unit either before commencement of or during venom immunotherapy answered a questionnaire addressing various aspects of their intended after-Sting behavior. Using an EpiPen trainer device, patients' performance of EpiPen self-administration was evaluated. Results: Ninety-six patients participated in the study. Seventy-six of them were equipped with an EpiPen device. Less than 30% of these patients carried it at all times. After re-Sting, 50 (54%) patients planned to wait for the development of other symptoms before taking any further action. Twenty-two percent of the patients said that after re-Sting they would immediately administer their EpiPen. Proper EpiPen administration technique was demonstrated by 44% of the patients. Having not reached the maintenance dose correlated with a better compliance with carrying of the EpiPen. EpiPen instruction provided by an allergist correlated with a better EpiPen administration technique by the patients. Conclusion: Many patients with venom allergy hold wrong ideas about after-Sting behavior. Compliance with carrying EpiPen at all times and the ability to correctly administer it are both poor in most patients. Thorough and probably repeated instruction, both written and oral, provided by knowledgeable physicians is mandatory. (J Allergy Clin Immunol 2000;106:1184-9.)
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debilitating beliefs emotional distress and quality of life in patients given immunotherapy for Insect Sting allergy
Clinical & Experimental Allergy, 1999Co-Authors: R Confinocohen, Samuel Melamed, Arnon GoldbergAbstract:Background Patients who receive immunotherapy for systemic reaction to Insect Stings are told that once they reach maintenance dose they are almost 100% protected against future systemic reactions. However, we have observed that some patients continued to perceive themselves as highly debilitated by the allergy, and this perception had a significant impact on their quality of life. Objective To validate this clinical observation and to explore possible reasons for such an undesired psychological reaction. Methods The study group consisted of 97 patients who regularly attended an allergy outpatient clinic for venom immunotherapy, and who had been under medical surveillance for up to 8 years. They completed a questionnaire measuring debilitating beliefs, preoccupation with the systemic reaction event, emotional distress, perceived restriction by allergy, and perceived quality of life. We also recorded the duration of immunotherapy, physician-graded severity of the systemic reaction and the frequency at which immunotherapy was administered. The reference group consisted of patients who had not reached maintenance dose and were still at risk of recurrent systemic reactions. Results As many as one-third of the patients held self-imposed debilitating beliefs, were preoccupied with the systemic reaction event, perceived a moderate to severe impairment in their quality of life, and manifested symptoms of emotional distress. These psychological responses did not correlate with the immunotherapy dosage that had been reached. Patients who reached a full maintenance dose were doing no better psychologically than those in the reference group. Moreover, the length of time on immunotherapy did not result in attenuation of the psychological responses. Conclusion This study demonstrates for the first time, the long-laSting psychological impact of a threatening systemic reaction. It suggests a need for intervention aimed at dispelling patients' unfounded and persiSting debilitating beliefs.
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timing of venom skin tests and ige determinations after Insect Sting anaphylaxis
The Journal of Allergy and Clinical Immunology, 1997Co-Authors: Arnon Goldberg, Ronit ConfinocohenAbstract:Determinat ion of venom-specific IgE either by skin teSting or by RAST is a prerequisite for the correct diagnosis and t reatment of patients who have had a systemic reaction (SR) caused by an Insect Sting. Over the past 30 years the routine recommendat ion has been to postpone tests for specific IgE determinat ion for varying periods of time after the SR. TM Initially, delay in teSting was recommended because of the expectation of false-negative results from teSting with whole-body Insect extract soon after anaphylaxis. This recommendation has not been revised, since teSting with venoms became available. To assess whether venom skin tests (STs) and serum venom-specific (SVS)-IgE determinations have any value when performed shortly after the Insect Sting and to determine possible kinetics of these tests in other clinical situations of venom hypersensitivity, we investigated patients with Insect Sting-induced SR or large local reaction (LLR). Patients were evaluated twice: within i week of and 4 to 6 weeks after the Sting.
David B K Golden - One of the best experts on this subject based on the ideXlab platform.
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Insect Sting allergy new guidelines from the european and usa consensus groups algorithms and recommendations
Current Opinion in Allergy and Clinical Immunology, 2019Co-Authors: David B K GoldenAbstract:Purpose of reviewGuidelines on Insect Sting allergy and venom immunotherapy (VIT) have been updated. This review describes the evolution of these guidelines and their similarities and differences.Recent findingsThe US and European guidelines show the evolution of guideline development in the grading
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Epidemiology, Diagnosis, and Treatment of Hymenoptera Venom Allergy in Mastocytosis Patients
Immunology and allergy clinics of North America, 2014Co-Authors: Marek Niedoszytko, Patrizia Bonadonna, David B K GoldenAbstract:Hymenoptera venom allergy is a typical IgE-mediated reaction caused by sensitization to 1 or more allergens of the venom, and accounts for 1.5% to 34% of all cases of anaphylaxis. Patients suffering from mastocytosis are more susceptible to the anaphylactic reactions to an Insect Sting. This article aims to answer the most important clinical questions raised by the diagnosis and treatment of Insect venom allergy in mastocytosis patients. Total avoidance of Hymenoptera is not feasible, and there is no preventive pharmacologic treatment available, although venom immunotherapy reduces the risk of subsequent systemic reactions.
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Insect Sting allergy and venom immunotherapy
Annals of Allergy Asthma & Immunology, 2006Co-Authors: David B K GoldenAbstract:Objective To review specific aspects of venom immunotherapy (VIT) in the context of allergen immunotherapy (AIT) in general. Data Sources Immunotherapy Collegium II presented at the 2005 Annual Meeting of the American College of Allergy, Asthma and Immunology. Study Selection Discussions of VIT during Immunotherapy Collegium II. Results The decision to recommend VIT is based on a detailed history and confirmatory diagnostic tests, as well as a knowledge of the natural history of the disease and its impact on quality of life. Skin tests and radioallergosorbent tests are complementary in that neither can detect all cases of Insect Sting allergy. Unlike inhalant AIT, rush regimens are as safe as slower regimens for initial VIT, and 4- to 8-week maintenance intervals are typical for VIT. In contrast to inhalant AIT, large local reactions are common and expected with VIT and should not limit the maintenance dose. VIT induces full immune tolerance in 85% of patients after 5 years, whereas this occurs in 30% to 50% of patients with inhalant AIT. VIT is often discontinued after 5 years even though skin test results are usually still positive, but a 10% to 15% chance of reaction persists for many years and is greater in patients who had near-fatal reactions before treatment, those who had systemic reactions during VIT, those with honeybee allergy, and those treated for less than 5 years. Children who receive 3 to 5 years of VIT have a laSting immune tolerance for 10 to 20 years afterward. Conclusion The appropriate use of VIT for prevention of Insect Sting allergy requires knowledge of the natural history of the disease and would benefit from a better understanding of the mechanisms of successful immunotherapy for the induction of immune tolerance.
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Insect Sting allergy and venom immunotherapy a model and a mystery
The Journal of Allergy and Clinical Immunology, 2005Co-Authors: David B K GoldenAbstract:Whole-body extracts of Hymenoptera were used for diagnosis and treatment until controlled clinical trials proved them no better than placebo, whereas venom is 85% to 98% effective. Studies of natural history reveal why whole-body extracts were thought to work. The chance of future systemic reactions is low in large local reactors and in most children and varies between 20% and 70% in adults. Venom skin tests are most accurate, but RAST is an important complementary test. The degree of sensitivity on skin tests or RASTs does not reliably predict the severity of a Sting reaction. Venom immunotherapy is recommended for patients at high risk for Sting reactions. Rapid regimens are as safe as slower regimens. The recommended dose is 100 μg, but some patients require higher doses for full protection. Venom immunotherapy is continued every 4 to 8 weeks for at least 5 years in most cases. Skin test results become negative in only 25% after 5 years of therapy but in 60% to 70% after 7 to 10 years. When treatment is stopped after 5 years or more, there is a 10% chance of systemic reaction to each future Sting, but most reactions are mild. Some patients have a higher risk of relapse and should continue treatment for an extended period.
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Insect Sting allergy with negative venom skin test responses
The Journal of Allergy and Clinical Immunology, 2001Co-Authors: David B K Golden, Anne Kageysobotka, Philip S Norman, Robert G. Hamilton, Lawrence M LichtensteinAbstract:Abstract Background: In our 1976 controlled venom immuno rapy trial, 33% of 182 patients with a history of systemic reactions to Insect Stings were excluded because of negative venom skin test responses. There have been reports of patients with negative skin test responses who have had severe reactions to subsequent Stings. Objective: Our aim is to increase awareness about the patient with a negative skin test response and Insect Sting allergy and to determine the frequency and significance of negative skin test responses in patients with a history of systemic reactions to Insect Stings. Methods: We prospectively examined the prevalence of negative venom skin test responses in patients with a history of systemic reactions to Stings. In patients who gave informed consent, we analyzed the outcome of reteSting and Sting challenge. Results: Of 307 patients with positive histories screened for our Sting challenge study, 208 (68%) had positive venom skin test responses (up to 1 μg/mL concentration), and 99 (32%) had negative venom skin test responses. In 36 (36%) of the 99 patients with negative skin test responses, the venom RAST result was a low positive (1-3 ng/mL), or repeat venom skin test responses were positive; another 7 (7%) patients had high venom-specific IgE antibody levels (4-243 ng/mL). Notably, 56 (57%) of 99 patients with positive histories and negative skin test responses had negative RAST results. In patients with positive skin test responses, Sting challenges were performed in 141 of 196 patients, with 30 systemic reactions. Sting challenges were performed on 37 of 43 patients with negative skin test responses and positive venom-specific IgE and in 14 of 56 patients with negative skin test responses and negative RAST results. There were 11 patients with negative skin test responses who had systemic reactions to the challenge Sting: 2 had negative RAST results, and 9 had positive RAST results at 1 ng/mL. The frequency of systemic reaction was 21% in patients with positive skin test responses and 22% in patients with negative skin test responses (24% in those with positive RAST results and 14% in those with negative RAST results). Conclusions: Venom skin test responses can be negative in patients who will subsequently experience another systemic Sting reaction. Venom skin test responses are negative in many patients with a history of systemic allergic reactions to Insect Stings and may be associated with positive serologic test responses for venom-specific IgE antibodies (sometimes strongly positive results). Venom skin test responses should be repeated when negative, along with a serologic IgE antivenom test. Better diagnostic skin test reagents are urgently needed. (J Allergy Clin Immunol 2001;107:897-901.)
Ronit Confinocohen - One of the best experts on this subject based on the ideXlab platform.
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debilitating beliefs and emotional distress in patients given immunotherapy for Insect Sting allergy a prospective study
Allergy and Asthma Proceedings, 2009Co-Authors: Ronit Confinocohen, Samuel Melamed, Arnon GoldbergAbstract:Patients who receive venom immunotherapy (VIT) for systemic reactions (SRs) to Insect Stings are advised that once they reach the maintenance dose they are almost 100% protected against future SRs. However, initial evidence indicates that some patients continue to perceive themselves as highly debilitated by the allergy and are preoccupied with the allergic event. These factors have significant impact on their emotional well-being and allergy-related quality of life (ARQOL). We aimed to explore prospectively whether patients would experience these adverse psychological outcomes after receiving VIT coupled with professional explanation and reassurance of protection. Thirty-four patients who received VIT for systemic Insect allergy and were under close medical surveillance were included. Before and 1 year after initiation of treatment, patients completed a questionnaire that measured debilitating beliefs, preoccupation with the SR event, emotional distress ARQOL, and QOL in general. Physician-graded severity of the reaction was recorded as well. VIT had a beneficial effect on all allergy-related variables. Self-imposed debilitating beliefs, preoccupation with the anaphylactic event, and ARQOL significantly but modestly improved over time. No association was found between ARQOL and QOL in general. The later variable as well as emotional distress remained unchanged after the VIT. This study shows that patients with Sting allergy guided by trained personnel and treated with VIT show a reduction in dysfunctional beliefs and an improvement in ARQOL. Disputing medically unfounded beliefs that persist in some patients might improve their ARQOL.
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Insect Sting inflicted systemic reactions attitudes of patients with Insect venom allergy regarding after Sting behavior and proper administration of epinephrine
The Journal of Allergy and Clinical Immunology, 2000Co-Authors: Arnon Goldberg, Ronit ConfinocohenAbstract:Abstract Background: Patients with Insect venom allergy are at higher risk for development of a recurrent systemic reaction after re-Sting. This risk significantly decreases with venom immunotherapy. Patients with Insect venom allergy should be able to diStinguish a life-threatening systemic reaction from all other various reactions after an Insect Sting. Accidental epinephrine injection by EpiPen has been reported in the past. Therefore patients with venom allergy should also be well trained in self-administration of their epinephrine when needed. Objective: Our objective was to assess patients' attitudes regarding after-Sting behavior and their capability to correctly self-administer the epinephrine autoinjector. Methods: All patients with venom allergy attending our allergy unit either before commencement of or during venom immunotherapy answered a questionnaire addressing various aspects of their intended after-Sting behavior. Using an EpiPen trainer device, patients' performance of EpiPen self-administration was evaluated. Results: Ninety-six patients participated in the study. Seventy-six of them were equipped with an EpiPen device. Less than 30% of these patients carried it at all times. After re-Sting, 50 (54%) patients planned to wait for the development of other symptoms before taking any further action. Twenty-two percent of the patients said that after re-Sting they would immediately administer their EpiPen. Proper EpiPen administration technique was demonstrated by 44% of the patients. Having not reached the maintenance dose correlated with a better compliance with carrying of the EpiPen. EpiPen instruction provided by an allergist correlated with a better EpiPen administration technique by the patients. Conclusion: Many patients with venom allergy hold wrong ideas about after-Sting behavior. Compliance with carrying EpiPen at all times and the ability to correctly administer it are both poor in most patients. Thorough and probably repeated instruction, both written and oral, provided by knowledgeable physicians is mandatory. (J Allergy Clin Immunol 2000;106:1184-9.)
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timing of venom skin tests and ige determinations after Insect Sting anaphylaxis
The Journal of Allergy and Clinical Immunology, 1997Co-Authors: Arnon Goldberg, Ronit ConfinocohenAbstract:Determinat ion of venom-specific IgE either by skin teSting or by RAST is a prerequisite for the correct diagnosis and t reatment of patients who have had a systemic reaction (SR) caused by an Insect Sting. Over the past 30 years the routine recommendat ion has been to postpone tests for specific IgE determinat ion for varying periods of time after the SR. TM Initially, delay in teSting was recommended because of the expectation of false-negative results from teSting with whole-body Insect extract soon after anaphylaxis. This recommendation has not been revised, since teSting with venoms became available. To assess whether venom skin tests (STs) and serum venom-specific (SVS)-IgE determinations have any value when performed shortly after the Insect Sting and to determine possible kinetics of these tests in other clinical situations of venom hypersensitivity, we investigated patients with Insect Sting-induced SR or large local reaction (LLR). Patients were evaluated twice: within i week of and 4 to 6 weeks after the Sting.
U. Müller - One of the best experts on this subject based on the ideXlab platform.
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when can immunotherapy for Insect Sting allergy be stopped
The Journal of Allergy and Clinical Immunology: In Practice, 2015Co-Authors: U. Müller, Johannes RingAbstract:Stings by Hymenoptera (honey bees, vespids, ants) can cause systemic allergic reactions (SARs). Venom immunotherapy (VIT) is highly effective and reduces an allergic patient's risk of a recurrent SAR to less than 5-20%. The risk of a recurrent SAR to a re-Sting decreases the longer VIT is continued. The recommended duration of VIT is at least 3 to 5 years.Risk factors for recurrent SARs to a Sting after stopping VIT have been identified and discussed: Recommendations concerning stopping VIT: For patients without any of the identified risk factors, VIT should be continued for 5 rather than 3 years. In patients with definite risk factors, a longer duration of VIT has to be discussed before stopping it. In mast cell disorders, VIT for life is recommended. Because of the residual risk of SARs after VIT, all patients are advised to carry an epinephrine autoinjector indefinitely and to continue to take measures to avoid Hymenoptera Stings.
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side effects of Insect venom immunotherapy results from an eaaci multicenter study
Allergy, 2000Co-Authors: Holger Mosbech, U. MüllerAbstract:Background: The effect of venom immunotherapy (VIT) is well documented, but fear of systemic side-effects (SE) may prevent its use. The study aimed to analyze the character and frequency of SE and risk factors. Methods: In a prospective study, 19 European centers included patients starting on VIT for systemic reactions to Insect Stings. Various dose regimens were applied. Results: Data from 840 patients with a total of 26601 injections were obtained. Seventy-one percent were treated with Vespula-venom extract and 27% with honeybee-venom extract. Twenty percent of patients had SE corresponding to 1.9% of injections during dose increase and 0.5% during the maintenance phase. The vast majority of the 280 reactions were mild: only one-third required medical treatment. Injected or inhaled adrenaline was applied in six patients, of whom only one had a drop in blood pressure and collapse. Female sex, bee-venom extract, and rapid dose increase, but not severity of Insect Sting reactions, increased the risk of SE. The severity of SE was less in males but was not related to age, treatment phase, species of Insect, or severity of Insect Sting reactions. Conclusions: The frequency of SE was low, and the majority of thesecould be managed without treatment. Risk was increased in females, in bee-venom-treated patients, and in those with rapid dose increase.
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side effects of Insect venom immunotherapy results from an eaaci multicenter study european academy of allergology and clinical immunology
Allergy, 2000Co-Authors: Holger Mosbech, U. MüllerAbstract:BACKGROUND: The effect of venom immunotherapy (VIT) is well documented, but fear of systemic side-effects (SE) may prevent its use. The study aimed to analyze the character and frequency of SE and risk factors. METHODS: In a prospective study, 19 European centers included patients starting on VIT for systemic reactions to Insect Stings. Various dose regimens were applied. RESULTS: Data from 840 patients with a total of 26 601 injections were obtained. Seventy-one percent were treated with Vespula-venom extract and 27% with honeybee-venom extract. Twenty percent of patients had SE corresponding to 1.9% of injections during dose increase and 0.5% during the maintenance phase. The vast majority of the 280 reactions were mild: only one-third required medical treatment. Injected or inhaled adrenaline was applied in six patients, of whom only one had a drop in blood pressure and collapse. Female sex, bee-venom extract, and rapid dose increase, but not severity of Insect Sting reactions, increased the risk of SE. The severity of SE was less in males but was not related to age, treatment phase, species of Insect, or severity of Insect Sting reactions. CONCLUSIONS: The frequency of SE was low, and the majority of these could be managed without treatment. Risk was increased in females, in bee-venom-treated patients, and in those with rapid dose increase.
Holger Mosbech - One of the best experts on this subject based on the ideXlab platform.
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Insect Sting reactions and specific ige to venom and major allergens in a general population
International Archives of Allergy and Immunology, 2016Co-Authors: Holger Mosbech, Line Tang, Allan LinnebergAbstract:Background: Insect Sting reactions are frequently reported, but population studies documenting the frequency and the relation to IgE-sensitization and serum trypt
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side effects of Insect venom immunotherapy results from an eaaci multicenter study
Allergy, 2000Co-Authors: Holger Mosbech, U. MüllerAbstract:Background: The effect of venom immunotherapy (VIT) is well documented, but fear of systemic side-effects (SE) may prevent its use. The study aimed to analyze the character and frequency of SE and risk factors. Methods: In a prospective study, 19 European centers included patients starting on VIT for systemic reactions to Insect Stings. Various dose regimens were applied. Results: Data from 840 patients with a total of 26601 injections were obtained. Seventy-one percent were treated with Vespula-venom extract and 27% with honeybee-venom extract. Twenty percent of patients had SE corresponding to 1.9% of injections during dose increase and 0.5% during the maintenance phase. The vast majority of the 280 reactions were mild: only one-third required medical treatment. Injected or inhaled adrenaline was applied in six patients, of whom only one had a drop in blood pressure and collapse. Female sex, bee-venom extract, and rapid dose increase, but not severity of Insect Sting reactions, increased the risk of SE. The severity of SE was less in males but was not related to age, treatment phase, species of Insect, or severity of Insect Sting reactions. Conclusions: The frequency of SE was low, and the majority of thesecould be managed without treatment. Risk was increased in females, in bee-venom-treated patients, and in those with rapid dose increase.
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side effects of Insect venom immunotherapy results from an eaaci multicenter study european academy of allergology and clinical immunology
Allergy, 2000Co-Authors: Holger Mosbech, U. MüllerAbstract:BACKGROUND: The effect of venom immunotherapy (VIT) is well documented, but fear of systemic side-effects (SE) may prevent its use. The study aimed to analyze the character and frequency of SE and risk factors. METHODS: In a prospective study, 19 European centers included patients starting on VIT for systemic reactions to Insect Stings. Various dose regimens were applied. RESULTS: Data from 840 patients with a total of 26 601 injections were obtained. Seventy-one percent were treated with Vespula-venom extract and 27% with honeybee-venom extract. Twenty percent of patients had SE corresponding to 1.9% of injections during dose increase and 0.5% during the maintenance phase. The vast majority of the 280 reactions were mild: only one-third required medical treatment. Injected or inhaled adrenaline was applied in six patients, of whom only one had a drop in blood pressure and collapse. Female sex, bee-venom extract, and rapid dose increase, but not severity of Insect Sting reactions, increased the risk of SE. The severity of SE was less in males but was not related to age, treatment phase, species of Insect, or severity of Insect Sting reactions. CONCLUSIONS: The frequency of SE was low, and the majority of these could be managed without treatment. Risk was increased in females, in bee-venom-treated patients, and in those with rapid dose increase.