Hymenoptera venom allergy in outdoor workers: Occupational exposure, clinical features and effects of allergen immunotherapy

Abstract

Objectives. To describe (i) the clinical characteristics of workers, exposed to hymenoptera stings, with an ascertained diagnosis of Hymenoptera Venom Allergy (HVA), (ii) the specific role of occupational exposure, (iii) the effect of Venom Immunotherapy (VIT) in reducing the severity of allergic episodes in workers exposed to repeated stings of hymenoptera, and (iv) the management of the occupational consequences caused by allergic reactions due to hymenoptera stings.Methods. Between 2000 and 2013 an observational study, including patients referred to the regional reference hospital of Liguria, Italy, with an ascertained diagnosis of HVA and treated with VIT, was performed. A structured questionnaire was administered to all patients to investigate the occupational features of allergic reactions. These were graded according to standard systems in patients at the first episode, and after re-stings, during VIT.Results. One-hundred and 8four out of the 202 patients referred had a complete data set. In 32 (17.4%) patients, the allergic reaction occurred during work activities performed outdoor. Of these, 31.2% previously stung by hymenoptera at work, and receiving VIT, were re-stung during occupational activity. The grades of reaction developed under VIT treatment resulted clinically less severe than of those occurred at the first sting (p-value = 0.031).Conclusion. Our findings confirmed the clinical relevance of HVA, and described its occupational features in outdoor workers with sensitization, stressing the importance of an early identification and proper management of the professional categories recognized at high risk of hymenoptera stings. The Occupational Physician should be supported by other specialists to recommend appropriate diagnostic procedures and the prescription of VIT, which resulted an effective treatment for the prevention of episodes of severe reactions in workers with a proven HVA.

Hymenoptera Venom Allergy: Management of Children and Adults in Clinical Practice

“…In addition to beekeepers [13], for whom a specific risk is recognized, other workers such as foresters, farmers, gardeners, truck drivers, masons, and electricians [258,259] also experience systemic reactions more frequently, as do greenhouse workers, who are exposed to bumblebee stings [8,260]. For these categories, hymenoptera venom allergy can be considered an occupational disease [259,261] necessitating specific primary prevention measures [262]. Hymenoptera venom allergy is a recognized cause of work disability that can require a worker to change or leave his/her profession in order to reduce the risk of exposure [263].…”

“…A recent Italian study conducted on 184 patients with anaphylactic reactions to hymenoptera venom showed an occupational cause in 17.4% of cases; of these, 71.8% continued to work after having received VIT. Re-stung workers (31.2%) were effectively protected [261]. The impact of VIT on professional activity increases with occupational risk [263].…”

Allergy and sensitization to Hymenoptera venoms in unreferred adults with a high risk of sting exposure

“…Although different methods used for assessing sensitization make it difficult to compare different populations, sting frequency and sensitization rates in warm, southern countries seem to be higher than in countries with a cooler climate3, 4: Studies from Sweden 3 and Denmark 1 showed sensitization rates of 9% and 15% respectively, while a study from Turkey 4 reported that 29% of the general population are sensitized. Similarly, individuals who spend a lot of time outside, such as those who hunt and fish, are prone to repeated stings and therefore have a very high risk of sensitization and venom allergy 6, 7, 8. However, there are few data on the prevalence of sensitization and allergy in these population groups.…”

Long-term impact of hymenoptera venom immunotherapy on clinical course, immune parameters, and psychosocial aspects

“…In summary, this survey demonstrates that 1) a substantial percentage of VIT-treated patients show a long-term loss of HV tolerance, 2) measurements of HV-specific antibodies do not allow an estimation of the clinical status of continued tolerance, and 3) VIT-treated individuals are affected differently in their daily life by emotional distress depending on whether they experienced a re-sting and whether or not they developed an SR. Our findings of an increased re-sting frequency over time (53.7% in a follow-up period of up to 29 years), and at least one fifth of these (6/29) showing loss of tolerance, together with the data from previous reports, firmly strengthen the recommendation for long-term VIT of HV-allergic patients exhibiting risk factors for developing severe SR, like suffering from cardiovascular disease, asthma, clonal mast cell disorders, severe prior SR, increased age, or/and showing increased probability of being stung again due to bee-keeping, outdoor leisure activities, or professional hymenoptera exposure (e.g., working as a gardener, farmer, forest or construction worker, fruit or pastry seller [ 1 , 8 , 44 , 45 ]). This might also hold true for HV-allergic subjects experiencing psychological or emotional distress when close to hymenoptera, which could have profound impact on behavioral patterns and personal feelings, as revealed by the answers to our questionnaire and by other similar investigations.…”