Bee and ant stings are a rite of passage in childhood, part of the halcyon days of running through woods and turning over rocks. But for children who are allergic to stings, that experience can be traumatic, causing the airway to close and sometimes leading even to death. Physicians and parents are often under the impression that children will outgrow their allergies, and that all but very severe reactions don't require treatment. A group of researchers from Johns Hopkins University decided to test that idea.

What the researchers wanted to know: Do children who are allergic to insect stings outgrow their allergies?

What they did: The researchers had done previous studies on a group of more than 1,000 children in the late 1970s and 1980s who'd had an allergic reaction to an insect sting. Some of those children received venom immunotherapy, meaning that purified forms of the insect venom were used to treat their allergies, while some of them had no treatment. They tracked down these people, now adults, and called them, reaching about half of the original study participants. The researchers asked whether the people had been stung again and how severe their reactions were to the second sting.

What they found: Fewer people who received venom immunotherapy had severe reactions to a second sting than those who had been given no treatment. Most children do outgrow their allergies, but a significant number did not and were aided by venom immunotherapy. Seventeen percent of people who never received treatment for their allergies had a systemic reaction to a second sting, while only 3 percent of those who had immunotherapy had a similar reaction when stung again. For patients who had moderate-to-severe systemic reactions in childhood but were not treated the risk was even greater; 32 percent had a systemic reaction to a second sting.

What it means to you: Immunotherapy has not been widely recommended because of the idea that all children grow out of their allergies. It requires many shots, can be expensive, and can itself cause an allergic reaction. However, as this study points out, it has benefits that are underappreciated, and it should be considered in more cases.

Caveats: A follow-up done this long after an initial study can have some biases. One is that people tend to respond if they think they have something to say—for example, if they had a horrible reaction to a sting. Also, many of the people had to think back more than 15 years and so might not have remembered a sting that did not cause an allergic reaction. So, the reported reaction to insect stings might be a bit overstated.

Find out more: For treatment of normal stings, without allergic reaction, the Providence Health Care system in Portland, Ore., has a page with good information.

For people with allergies, the American Academy of Allergy, Asthma and Immunology has a page on how to recognize harmful insects and treat allergies.

Read the article: Golden, D.B.K., Kagey-Sobotka, A., Norman, P.S., Hamilton, R.G., Lichtenstein, L.M. Outcomes of Allergy to Insect Stings in Children, With and Without Venom Immunotherapy. New England Journal of Medicine. Aug. 12, 2004, Vol. 351, No. 7, pp. 668–674.

Abstract online: http://content.nejm.org/