Anaphylaxis Secondary to Bee Sting

Clinical Presentation

The American Academy of Allergy, Asthma, and Immunology recommends that anaphylaxis be diagnosed based on a clinical presentation involving multiple organ systems, including hypotension with tachycardia, generalized urticaria, and wheezing, which are characteristic of Hymenoptera-induced anaphylaxis 1, 2
The clinical presentation of anaphylaxis typically involves the classic triad of cardiovascular, cutaneous, and respiratory manifestations, with symptom onset within 15 minutes of the sting, which is a critical distinction for diagnosis and treatment 2, 5

The pathophysiologic basis of anaphylaxis involves a Type I immediate hypersensitivity reaction, where bee venom proteins trigger cross-linking of venom-specific IgE antibodies on mast cells and basophils, causing sudden massive mediator release, including histamine, tryptase, leukotrienes, and prostaglandins 2, 5
Increased vascular permeability is the hallmark pathophysiologic feature of anaphylaxis, allowing transfer of up to 50% of intravascular fluid into the extravascular space within 10 minutes, which can cause distributive shock with profound hypotension 4

The American Heart Association recommends immediate intramuscular epinephrine 0.3-0.5 mg (anterolateral thigh) as mandatory and life-saving for anaphylaxis, which should not be delayed, as anaphylaxis is a clinical diagnosis that must be made rapidly 6, 3
Venom immunotherapy (VIT) is indicated for adults with systemic reactions involving cardiovascular and respiratory systems who have positive venom-specific IgE antibodies, which can reduce the risk of future systemic reactions to as low as 5% 7, 4