Purpose of review: Some aspects of insect sting allergy are unique in children. This review will identify and update the published data that exist pertaining specifically to insect allergy in children.
Recent findings: Children have a different pattern of insect sting allergy than adults. Honeybee allergy is more common in children. Severe systemic reactions are less common than in adults but the risk of recurrence can persist for decades. Systemic reactions are limited to mild 'cutaneous' reactions in over 60% of children (but only 15% of adults). Children with mild systemic reactions rarely get worse. Children with moderate or severe systemic reactions still had a 30% chance of a similar reaction even 20 years later. The long-term immune tolerance induced by venom immunotherapy is greater in children than adults. Children who had received venom immunotherapy for 3-5 years were still immune 10-20 years later.
Summary: Children with insect sting allergy are tested and treated in much the same way as adults. Children with mild systemic reactions do not require testing or immunotherapy. Children with moderate to severe systemic reactions are at risk for decades and should receive venom immunotherapy, which gives very long-lasting protection.