Bee and wasp sting reactions in current beekeepers

Background: A majority of subjects allergic to bee venom are beekeepers, their relatives, or neighbors. Predetermining systemic reactivity to honeybee stings and risk assessment through laboratory tests have been unsatisfactory. Objective: To estimate the prevalence and type of sting reactions, and especially to evaluate potential risk factors of systemic reactions in beekeepers. Methods: A questionnaire concerning sting reactions and potential risk factors was mailed to all members of the regional beekeepers' association; 191 beekeepers were included in the study. Results: Systemic bee sting reactions were present in 50 (26%) and large local reactions in 73 (38%) of the beekeepers. Similar reactions following wasp stings were present in 2% and 13%, respectively. Twenty-four (48%) of the systemic reactors and 39 (28%) of the remaining subjects had a history of atopic symptoms (allergic rhinitis, allergic bronchial asthma, or atopic dermatitis), While working at hives, nasal and eye symptoms were present in 54% of the systemic reactors and in 23% of the remaining subjects. Systemic reactors were younger and had been beekeepers for a shorter period than nonreactive subjects. Multiple logistic regression analysis showed that the risk of systemic sting reaction increased fourfold when nasal or eye symptoms were present while working at hives and twofold when the years in beekeeping were less than 15. Conclusions: The occurrence of systemic and large local reactions after bee stings is high among beekeepers. A history of atopy is associated with systemic reactions. Both the presence of nasal or eye symptoms while working at hives and a history of beekeeping less than 15 years significantly increase the risk of systemic reactions.