Risk assessment in determining systemic reactivity to honeybee stings in beekeepers

Background: The use of laboratory tests as a reliable method for risk assessment in determining the systemic reactivity of beekeepers to honeybee stings has proven unsatisfactory. Objective: This study was conducted to evaluate the usefulness of a structured questionnaire as a supplement to bee venom-specific IgE data in the prediction of systemic sting reactions of 78 beekeepers to honeybee stings. Methods: Participants in previous studies completed a questionnaire concerning potential risk factors of systemic sting reactions. Serum bee venom IgE was measured by CAP-RAST. Skin prick tests were performed with standardized bee venom extracts prior to the beekeeping season. Venom challenges were performed using unintentional field stings, A new questionnaire concerning sting reactions during the recent beekeeping season was sent to the beekeepers after it had ended. A multiple logistic regression analysis was done to evaluate the influence of potential risk factors upon systemic bee sting reactions. Results: Four variables were significant, The pre-season presence of serum bee venom-specific IgE at concentrations exceeding 1.0 kU/L increased the risk of systemic reactions 12-fold. The risk was 10-fold if nasal or respiratory symptoms had occurred while working at hives, When the years spent in beekeeping were fewer than eight the risk of systemic sting reaction was 9-fold, any previous systemic reaction increased the risk 8-fold. Conclusion: The use of more detailed patient histories in combination with laboratory tests may markedly improve the reliability of risk assessment.