Clinical Predictors for Systemic Reaction in Children with Hymenoptera Sting: A Southeast Asian Experience.

Introduction: Insect bites and stings are common in the paediatric age group. Hymenoptera stings (hornets, wasps, bees and ants) are the leading cause of insect anaphylaxis. The post-envenomation severity varies and is unpredictable, ranging from local to severe systemic reactions. This study aimed to explore the prevalence and predictors of severe systemic reactions post Hymenoptera stings. Methods: A retrospective review of the medical records of paediatric patients with Hymenoptera stings, admitted to two major tertiary centres from January 2014 to December 2018, was conducted. Baseline characteristics, including age, positive history of atopy, type of insects, clinical manifestations (localised or systemic) and complications, were documented. The prevalence of systemic reaction was determined using descriptive statistics. Simple logistic regression and multiple logistic regression were used to determine the factors causing systemic reaction among children with alleged Hymenoptera stings. Results: There were 459 children in the study, predominantly male (n = 300 (65.4%)). The prevalence of systemic reaction in our cohort was 24.8% (n = 114). The majority of cases were hornet stings (n = 333), followed by bees (n = 78), wasps (n = 26) and ants (n = 22), respectively. Older children (OR = 1.13, 95% CI: 1.07-1.19), history of allergy (OR = 4.16, 95% CI: 1.86-9.29), history of atopy (OR = 2.77, 95% CI: 1.49-5.15), and number of sting (OR = 1.08, 95% CI: 1.01-1.15) were associated with higher likelihood of systemic reaction. Conclusion: Older children with a history of allergy or atopy and more stings were identified as increased risk factors for developing systemic reactions. [ABSTRACT FROM AUTHOR]