Hymenoptera venom allergy ranks among the top three causes of anaphylaxis worldwide, and approximately one‐quarter of sting‐induced reactions are classified as severe. Fatal sting reactions are exceedingly rare, but certain factors may entail a considerably higher risk. Delayed administration of epinephrine and upright posture are situational risk factors which may determine an unfavorable outcome of the acute anaphylactic episode and should be addressed during individual patient education. Systemic mastocytosis and senior age are major, unmodifiable long‐term risk factors and thus reinforce the indication for venom immunotherapy. Vespid venom allergy and male sex likewise augment the risk of severe or even fatal reactions. Further studies are required to assess the impact of specific cardiovascular comorbidities. Available data regarding potential effects of beta‐blockers and/or ACE inhibitors in coexisting venom allergy are inconclusive and do not justify recommendations to discontinue guideline‐directed antihypertensive treatment. The absence of urticaria/angioedema during sting‐induced anaphylaxis is indicative of a severe reaction, serum tryptase elevation, and mast cell clonality. Determination of basal serum tryptase levels is an established diagnostic tool for risk assessment in Hymenoptera venom‐allergic patients. Measurement of platelet‐activating factor acetylhydrolase activity represents a complementary approach but is not available for routine diagnostic use.

中文翻译：

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严重全身性昆虫叮咬反应的危险因素和指标

膜翅目昆虫毒液过敏是全球过敏反应的三大原因之一，大约四分之一的叮咬引起的反应被归类为严重的。致命的刺痛反应极为罕见，但某些因素可能会带来相当高的风险。延迟给予肾上腺素和直立姿势是情境风险因素，可能决定急性过敏性发作的不利结果，应在个别患者教育中加以解决。系统性肥大细胞增多症和高龄是主要的、不可改变的长期危险因素，因此加强了毒液免疫治疗的适应症。胡蜂毒液过敏和男性同样会增加严重甚至致命反应的风险。需要进一步的研究来评估特定心血管合并症的影响。关于 β 受体阻滞剂和/或 ACEI 对共存毒液过敏的潜在影响的现有数据尚无定论，不能证明停止指南指导的抗高血压治疗的建议是合理的。刺痛引起的过敏反应期间没有荨麻疹/血管性水肿表明严重反应、血清类胰蛋白酶升高和肥大细胞克隆。测定基础血清类胰蛋白酶水平是膜翅目毒液过敏患者风险评估的成熟诊断工具。血小板活化因子乙酰水解酶活性的测量是一种补充方法，但不适用于常规诊断用途。刺痛引起的过敏反应期间没有荨麻疹/血管性水肿表明严重反应、血清类胰蛋白酶升高和肥大细胞克隆。测定基础血清类胰蛋白酶水平是膜翅目毒液过敏患者风险评估的成熟诊断工具。血小板活化因子乙酰水解酶活性的测量是一种补充方法，但不适用于常规诊断用途。刺痛引起的过敏反应期间没有荨麻疹/血管性水肿表明严重反应、血清类胰蛋白酶升高和肥大细胞克隆。测定基础血清类胰蛋白酶水平是膜翅目毒液过敏患者风险评估的成熟诊断工具。血小板活化因子乙酰水解酶活性的测量是一种补充方法，但不适用于常规诊断用途。