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Management of Hymenoptera Venom Allergy in Türkiye: Observational Data from Ege University
Cihan Ural1, Ali Kokuludağ2, Aytül Zerrin Sin2, Ramazan Ersoy3, Okan Gülbahar21Van Yüzüncü Yıl University, Faculty of Medicine, Department of İnternal Medicine, Van, Türkiye2Ege University, Faculty of Medicine, Department of İnternal Medicine, Division of Allergy and Clinical Immunology, İzmir, Türkiye
3Clinic of Allergy Diseases, Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, Istanbul, Turkey
INTRODUCTION: Hymenoptera venom allergy is a major cause of IgE-mediated anaphylaxis. Optimal management includes prompt adrenaline administration, referral to an allergy specialist, prescription of an adrenaline autoinjector, and initiation of venom immunotherapy (VIT). Despite well-established international guidelines, adherence to recommended practices in real-world settings remains suboptimal.
METHODS: Medical records of 238 patients diagnosed with bee venom allergy at the our clinic between 1999 and 2010 were reviewed. Collected data included demographic characteristics, sting location, reaction severity (Mueller classification), acute emergency management (adrenaline administration and specialist referral), diagnostic testing (skin prick test and venom-specific IgE), adrenaline autoinjector prescription, and VIT-related outcomes (initiation, safety, and efficacy).
RESULTS: Systemic reactions occurred in 92.4% of patients, with 76.4% classified as severe (Mueller grades 3–4). Neck stings were significantly associated with severe reactions (95% grade 3–4; p = 0.011). Adrenaline was administered in 43% of acute reactions, 24% were referred to an allergy specialist, and 35.5% received an autoinjector prescription. Venom sensitization was confirmed in 86.5%. Although VIT was recommended for 163 patients, only 50.9% initiated therapy. During VIT, 31% had mild-to-moderate injection reactions, with no severe systemic events. No systemic reactions occurred after re-sting in patients who completed VIT.
DISCUSSION AND CONCLUSION: The management of Hymenoptera venom allergy in Türkiye remains suboptimal, primarily due to underuse of adrenaline, low referral rates to allergy specialists, and limited uptake of VIT. Strategies aimed at improving physician education, standardizing emergency management protocols, and enhancing access to VIT are essential to optimize patient outcomes and ensure guideline-concordant care.
Keywords: Hymenoptera venom, anaphylaxis, emergency treatmen, diagnostic testing, adrenaline autoinjector, venom immunotherapy.
Manuscript Language: English