Discussion by the Insect Stings group of the SFA of a clinical case involving a toxic reaction to a very large venom dose resulting from multiple insect stings

The "Insect Stings" group of the SFA discussed the case of a patient who presented with an immediate, generalized reaction following a hundred simultaneous wasp stings. After immediate treatment in the emergency room, recovery was complete in a few hours. The allergy workup done 6 weeks later showed sensitization to yellow jackets. The group decided that a negative result in a subsequent workup would mean that the patient had had a toxic reaction to the venom. If the result was positive, then it could not be distinguished from true allergic sensitization to vespula. The patient was seen 6 months later and the skin tests and specific IgE assay showed a significant reduction in sensitivity, which led to the conclusion that the reaction was toxic in nature. Nevertheless, the patient was given an emergency kit containing an adrenalin syringe. This case allows us to recall the syndrome of massive-dose venom toxicity and to consider the pharmacological properties of hymenoptera venoms, which illustrate its toxicity. (c) 2012 Published by Elsevier Masson SAS.