{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T22:44:02Z","timestamp":1791499442967,"version":"4.3.4"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,11,26]],"date-time":"2021-11-26T00:00:00Z","timestamp":1637884800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Hymenoptera stings are generally well-tolerated and usually cause limited local reactions, characterized by self-resolving erythema and edema associated with pain. However, Hymenoptera stings can induce immediate and delayed hypersensitivity reactions. In addition to these manifestations, unusual reactions to Hymenoptera stings have been reported. The latter are defined as unusual because of their atypical characteristics. They may differ from classical hypersensitivity reactions due to the stings' particular localization and the unusual involvement of one or more specific organs. Although unusual reactions to Hymenoptera stings are infrequent, it is essential for clinicians to know the possible related clinical manifestations. Here, we review the available literature and propose a diagnostic and management algorithm. At present, there are no defined guidelines for most of the unusual reactions to Hymenoptera stings, which should be managed in a tailored way according to the specifical clinical manifestations presented by the patients. Further studies are needed to better define these conditions and the underlying pathogenetic mechanisms to improve the diagnostic and therapeutic approach.<\/jats:p>","DOI":"10.3389\/fmed.2021.717290","type":"journal-article","created":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T06:13:16Z","timestamp":1638339196000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":10,"title":["Unusual Reactions to Hymenoptera Stings: Current Knowledge and Unmet Needs in the Pediatric Population"],"prefix":"10.3389","volume":"8","author":[{"given":"Riccardo","family":"Castagnoli","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mattia","family":"Giovannini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Mori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona","family":"Barni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Pecoraro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefania","family":"Arasi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Saretta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla","family":"Mastrorilli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia","family":"Liotti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia","family":"Caminiti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gunter Johannes","family":"Sturm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gian Luigi","family":"Marseglia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elio","family":"Novembre","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,11,26]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"180","DOI":"10.18176\/jiaci.0310","article-title":"Hymenoptera venom allergy: management of children and adults in clinical practice","volume":"29","author":"Bil\u00f2","year":"2019","journal-title":"J Investig Allergol Clin Immunol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1016\/0091-6749(89)90417-X","article-title":"Late-onset allergic reactions, including serum sickness, after insect stings","volume":"84","author":"Reisman","year":"1989","journal-title":"J Allergy Clin Immunol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1007\/s12016-014-8434-y","article-title":"Unusual reactions to hymenoptera stings: what should we keep in mind?","volume":"47","author":"Mingomataj","year":"2014","journal-title":"Clin Rev Allergy Immunol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1111\/pai.13359","article-title":"Epidemiology of rare allergic diseases in children","volume":"31","author":"Mori","year":"2020","journal-title":"Pediatr Allergy Immunol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"395","DOI":"10.2500\/108854191779114239","article-title":"Unusual reactions to insect venoms","volume":"12","author":"Reisman","year":"1991","journal-title":"Allergy Proc."},{"key":"B6","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1016\/0091-6749(77)90024-0","article-title":"Unusual reactions following insect stings. Clinical features and immunologic analysis","volume":"59","author":"Light","year":"1977","journal-title":"J Allergy Clin Immunol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1097\/01.all.0000173782.35283.b6","article-title":"Unusual reactions to insect stings","volume":"5","author":"Reisman","year":"2005","journal-title":"Curr Opin Allergy Clin Immunol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2018\/5631372","article-title":"Serum metabolomics analysis in wasp sting patients","volume":"2018","author":"Yang","year":"2018","journal-title":"Biomed Res Int."},{"key":"B9","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1093\/milmed\/167.2.161","article-title":"Oropharyngeal hymenoptera stings: a special concern for airway obstruction","volume":"167","author":"Smoley","year":"2002","journal-title":"Mil Med."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1763","DOI":"10.1056\/NEJM199706123362419","article-title":"A Gastric \u201cbee-zoar","volume":"336","author":"Lynch","year":"1997"},{"key":"B11","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1097\/NRL.0b013e31818c7251","article-title":"Stroke due to bee sting","volume":"15","author":"Temizoz","year":"2009","journal-title":"Neurologist."},{"key":"B12","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1159\/000236592","article-title":"Adverse neurologic reactions to the sting of the imported fire ant","volume":"102","author":"Candiotti","year":"1993","journal-title":"Int Arch Allergy Immunol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1177\/000331970605700317","article-title":"Acute myocardial infarction after a European hornet sting: a case report","volume":"57","author":"Korantzopoulos","year":"2006","journal-title":"Angiology."},{"key":"B14","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1111\/j.1365-2249.2008.03714.x","article-title":"Allergy and the cardiovascular system","volume":"153","author":"Triggiani","year":"2008","journal-title":"Clin Exp Immunol."},{"key":"B15","doi-asserted-by":"publisher","first-page":"1545","DOI":"10.1515\/cclm-2016-0010","article-title":"Kounis syndrome: an update on epidemiology, pathogenesis, diagnosis and therapeutic management","volume":"54","author":"Kounis","year":"2016","journal-title":"Clin Chem Lab Med."},{"key":"B16","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1016\/j.ijcard.2017.04.008","article-title":"Kounis syndrome: a review article on epidemiology, diagnostic findings, management and complications of allergic acute coronary syndrome","volume":"242","author":"Abdelghany","year":"2017","journal-title":"Int J Cardiol."},{"key":"B17","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1016\/j.ijcard.2021.04.018","article-title":"Kounis syndrome: towards a new classification","volume":"341","author":"Giovannini","year":"2021","journal-title":"Int J Cardiol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1016\/j.ijcard.2021.05.038","article-title":"Reply to the letter: \u201cKounis syndrome: towards a new classification","volume":"339","author":"Giovannini","year":"2021"},{"key":"B19","doi-asserted-by":"publisher","first-page":"383","DOI":"10.23736\/S0026-4946.20.06007-7","article-title":"Kounis syndrome: a pediatric perspective","volume":"72","author":"Giovannini","year":"2020"},{"key":"B20","doi-asserted-by":"publisher","first-page":"294","DOI":"10.11909\/j.issn.1671-5411.2020.05.011","article-title":"Kounis syndrome: a clinical entity penetrating from pediatrics to geriatrics","volume":"17","author":"Giovannini","year":"2020","journal-title":"J Geriatr Cardiol."},{"key":"B21","first-page":"59","article-title":"Kounis syndrome: first series in Turkish patients","volume":"9","author":"Biteker","year":"2009","journal-title":"Anadolu Kardiyol Derg."},{"key":"B22","first-page":"133","article-title":"Acute pulmonary hemorrhage following a honeybee sting: a case report","volume":"31","author":"Lam","year":"1998","journal-title":"J Microbiol Immunol Infect."},{"key":"B23","doi-asserted-by":"publisher","first-page":"1009","DOI":"10.1081\/CLT-120026527","article-title":"Hornet sting induced systemic allergic reaction and large local reaction with bulle formation and rhabdomyolysis","volume":"41","author":"Lin","year":"2003","journal-title":"J Toxicol Clin Toxicol."},{"key":"B24","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1097\/BPB.0b013e32832d83f7","article-title":"Acute compartment syndrome of the hand after a wasp sting: a case report","volume":"19","author":"Sawyer","year":"2010","journal-title":"J Pediatr Orthop Part B."},{"key":"B25","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1007\/s11552-011-9338-4","article-title":"Pediatric compartment syndrome following an insect bite: a case report","volume":"6","author":"McKnight","year":"2011","journal-title":"Hand."},{"key":"B26","doi-asserted-by":"publisher","first-page":"734","DOI":"10.1007\/s004670050377","article-title":"Non-fatal acute renal failure due to wasp stings in children","volume":"11","author":"Vachvanichsanong","year":"1997","journal-title":"Pediatr Nephrol."},{"key":"B27","doi-asserted-by":"publisher","first-page":"2315","DOI":"10.1007\/s00467-012-2250-5","article-title":"Acute kidney injury following multiple wasp stings","volume":"27","author":"Nandi","year":"2012","journal-title":"Pediatr Nephrol."},{"key":"B28","doi-asserted-by":"publisher","first-page":"408","DOI":"10.1177\/1076029610366438","article-title":"Acute ITP due to insect bite: report of 2 cases","volume":"17","author":"Akbayram","year":"2011","journal-title":"Clin Appl Thromb."},{"key":"B29","first-page":"223","article-title":"Mass envenomations by honey bees and wasps","volume":"170","author":"Vetter","year":"1999","journal-title":"West J Med."},{"key":"B30","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1053\/j.ctsap.2006.10.002","article-title":"Hymenoptera stings","volume":"21","author":"Fitzgerald","year":"2006","journal-title":"Clin Tech Small Anim Pract."},{"key":"B31","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1542\/peds.2005-1075","article-title":"Massive honey bee envenomation-induced rhabdomyolysis in an adolescent","volume":"117","author":"Betten","year":"2006","journal-title":"Pediatrics."},{"key":"B32","doi-asserted-by":"publisher","first-page":"e83164","DOI":"10.1371\/journal.pone.0083164","article-title":"Clinical features of severe wasp sting patients with dominantly toxic reaction: analysis of 1091 cases","volume":"8","author":"Xie","year":"2013","journal-title":"PLoS ONE."},{"key":"B33","doi-asserted-by":"publisher","first-page":"1227","DOI":"10.1007\/s00431-010-1209-4","article-title":"Multiple hymenoptera stings in children: clinical and laboratory manifestations","volume":"169","author":"Broides","year":"2010","journal-title":"Eur J Pediatr."},{"key":"B34","doi-asserted-by":"publisher","first-page":"755","DOI":"10.1590\/S0037-86822011000600020","article-title":"Picadas de abelhas africanizadas: como trat\u00e1-las?","volume":"44","author":"Almeida RAM de","year":"2011","journal-title":"Rev Soc Bras Med Trop."},{"key":"B35","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1159\/000504043","article-title":"Delayed admission and management of pediatric acute kidney injury and multiple organ dysfunction syndrome in children with multiple wasp stings: a case series","volume":"9","author":"Ambarsari","year":"2019","journal-title":"Case Rep Nephrol Dial."},{"key":"B36","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1097\/PEC.0b013e3182045f47","article-title":"Massive hymenoptera envenomation in a 3-year-old","volume":"27","author":"West","year":"2011","journal-title":"Pediatr Emerg Care."},{"key":"B37","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1007\/s00467-002-0888-0","article-title":"Acute renal failure following massive attack by Africanized bee stings","volume":"17","author":"Bresolin","year":"2002","journal-title":"Pediatr Nephrol."},{"key":"B38","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1111\/j.1440-1754.1990.tb01073.x","article-title":"Multiple hornet (Vespa orientalis) stings with fatal outcome in a child","volume":"26","author":"Korman","year":"1990","journal-title":"J Paediatr Child Health."},{"key":"B39","first-page":"611","article-title":"A fatal case caused by massive honey bee stings","volume":"57","author":"Akyildiz","year":"2016","journal-title":"Turk J Pediatr."},{"key":"B40","doi-asserted-by":"publisher","first-page":"1026","DOI":"10.1111\/all.12437","article-title":"Anaphylaxis: guidelines from the European Academy of Allergy and Clinical Immunology","volume":"69","author":"Muraro","year":"2014","journal-title":"Allergy."},{"key":"B41","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1007\/s11739-018-1891-1","article-title":"In situ simulation in the management of anaphylaxis in a pediatric emergency department","volume":"14","author":"Barni","year":"2019","journal-title":"Intern Emerg Med."},{"key":"B42","doi-asserted-by":"publisher","first-page":"744","DOI":"10.1111\/all.13262","article-title":"EAACI guidelines on allergen immunotherapy: hymenoptera venom allergy","volume":"73","author":"Sturm","year":"2018","journal-title":"Allergy."},{"key":"B43","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1111\/cea.13807","article-title":"Immunotherapy for hymenoptera venom allergy compared with real-life stings: Are we doing our best?","volume":"51","author":"Pecoraro","year":"2021","journal-title":"Clin Exp Allergy."},{"key":"B44","doi-asserted-by":"publisher","first-page":"925","DOI":"10.1001\/archinte.158.8.925","article-title":"Survival after massive (>2000) africanized honeybee stings","volume":"158","author":"D\u00edaz-S\u00e1nchez","year":"1998","journal-title":"Arch Intern Med."},{"key":"B45","doi-asserted-by":"publisher","first-page":"e24492","DOI":"10.1097\/MD.0000000000024492","article-title":"Clinical manifestation of multiple wasp stings with details of whole transcriptome analysis two case reports","volume":"100","author":"Ou","year":"2021","journal-title":"Med."},{"key":"B46","doi-asserted-by":"publisher","first-page":"804","DOI":"10.1016\/j.aller.2020.04.003","article-title":"Hymenoptera venom allergy among children in Italy: time for pediatricians to take action","volume":"48","author":"Giovannini","year":"2020","journal-title":"Allergol Immunopathol."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2021.717290\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T06:13:24Z","timestamp":1638339204000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2021.717290\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,26]]},"references-count":46,"alternative-id":["10.3389\/fmed.2021.717290"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2021.717290","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,26]]},"article-number":"717290"}}