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Death as a result of a bee sting is uncommon in Australia. During the 22 years from 1960 to 1981, 25 individuals have been recorded by the Australian Bureau of Statistics as having died shortly after a bee sting. This gives a mortality incidence of 0.086/1 000 000 population per year, but may be an underestimate, as we report two additional fatalities that did not appear in the records of the Bureau of Statistics. South Australia has the highest mortality rate from bee stings of all the Australian States, with a recorded fatality rate of 0.26/1 000 000 population per year. As in other surveys, fatalities occur predominantly in men over 40 years of age, which suggests that there may be other contributory risk factors, for example, coronary atherosclerosis. No deaths were reported in individuals aged from six to 19 years, the age group in which bee-sting anaphylaxis is particularly common. It thus appears that the prevention of death per se is not a strong rationale for routine bee-venom immunotherapy in schoolchildren and young adults.

The clinical manifestations and circumstances of bee sting anaphylaxis have been studied retrospectively in 98 subjects. Most reactions occurred in children but the most severe reactions were seen in adult males, of whom 7 lost consciousness and 2 required cardiopulmonary resuscitation. Most stings causing anaphylaxis occurred on the unprotected feet whilst the subject was on lawn in the afternoons in December, January and February when the maximum daily temperature was between 20 and 30 degrees C. This is the temperature range when bees are particularly active in gathering pollen. However, a significantly greater frequency of anaphylactic reactions occurred at higher temperatures when bees are less active, suggesting that high environmental temperature may predispose the individual to greater exposure to bees or possibly to anaphylactic reactions per se. The presence of atopy did not appear to predispose subjects to bee venom hypersensitivity. Considerable anxiety and lifestyle alteration were identified in some subjects. The alleviation of this anxiety is considered an appropriate indication for bee venom immunotherapy.