The sting of the honeybee: an allergic perspective.

OBJECTIVE To provide a focused understanding of the uniqueness and special considerations of honeybee allergy. DATA SOURCES A PubMed search using the keywords honeybee, allergy, and hypersensitivity yielded the initial relevant articles. Additional significant sources cited in the reference lists of the initial articles were also used. STUDY SELECTION More than 130 articles were reviewed, and the most relevant references were selected for inclusion in this article. RESULTS The honeybee differs from other flying Hymenoptera from both an entomologic and allergic standpoint. The entomology literature is not often consulted by the allergist when addressing avoidance of honeybees. Beekeepers are a particular population at risk for honeybee exposure and allergy. Venom composition, sting mechanism, diagnostic evaluation, and immunotherapy efficacy and safety all have unique considerations specific to the honeybee. CONCLUSIONS Honeybee is a significant cause of venom hypersensitivity. By understanding unique behaviors of honeybees, proper avoidance measures may be addressed with patients. Honeybee venom is complex, and the delivery mechanism provides for a large but often variable amount of injected venom. Diagnosis of honeybee allergy by imperfect skin and serologic testing further complicated by cross-reactivity is often difficult. Generally, honeybee immunotherapy is less safe and less effective than for other flying Hymenoptera. Efforts to improve testing and immunotherapy are under way.