Does an extreme allergic reaction to one type of insect bite or sting
mean a higher probability of similar reactions to other insects? My
7-year old daughter is quite allergic to some mosquito bites. She was
recently stung by a yellow jacket and had just a normal, mild
reaction.

Should we expect from this history that my daughter will not be
serverely allergic to other insect stings, particularly bees?

I live in the Chicago, IL area.

Hello dlenef,

There is no hard and fast answer to your question.  Allergy to stings
is an extreme immune reaction to one or more of the components present
in whatever the stinging insect injects into the body.

Mosquitoes do not actually have venom.  They are not interested in
killing off or paralysing the organism that they sting, but only in
getting a good meal out of the event.

“For the mosquito, the blood meal is a matter of survival for the
species. These insects need blood to produce eggs. Since egg
production is involved, the blood-feeding mosquito is always a female.
Yes, it is the female mosquito that bites! Male mosquitoes do not
bite, even though we might hear them buzzing around at times….
…  Once the mosquito gets its stylets--that's what scientists call the
needle-sharp parts of the mouthpart--into the skin, it injects saliva.
The saliva contains chemicals that prevent the blood from clotting and
is what causes the itching following the bite.”
“In Mosquitoes, the Lady is a Vamp” by Tom Turpin, Extension
Entomologist, Purdue University
June 2003
http://www.agcom.purdue.edu/AgCom/news/archives/2003/June/030612OSLhtml.htm

Your daughter has become sensitized to at least one of the
anticoagulants in mosquito saliva. Since she did not react unduly to a
yellow jacket sting, this means that yellow jacket venom does not
contain any substances with a structure similar enough to mosquito
anticoagulants to set off an allergic response in your daughter.

At the time she was stung by the yellow jacket, she did not have an
already developed sensitivity to any components in its venom. 
HOWEVER, there is always a possibility that this event could have
caused her to become sensitized to yellow jacket venom.  If that has
been the case, then she will show an allergic reaction the next time
she is stung by a yellow jacket.

If she has developed sensitivity to yellow jacket venom, this might or
might not mean that she will have an allergic response to stings by
other types of bees and wasps.  What we are looking at here is a
phenomenon known as cross-reactivity.  Basically, an immune response
happens when structures on the surface of  T and B lymphocytes (a type
of white blood cell) react with a foreign substance. Whether this
happens depends on the shape of the molecule. Two molecules with a
similar shape can sometimes both stimulate a reaction by the same
cells. In that case, they are said to be cross-reactive. So if your
daughter has become sensitized to yellow jacket venom, she will also
be sensitized to venom from another type of wasp or bee if it contains
the same or a similar substance as the one in the yellow jacket venom.

“Bees, fire ants and vespids cause insect sting allergy. These insects
have unique as well as common venom allergens. Vespids, including
hornets, paper wasps and yellow jackets, have common allergens. Bees
and vespids have one common allergen with hyaluronidase activity; they
also have unique allergens with different phospholipase activities.
Fire ants and vespids have one common allergen, antigen 5 of unknown
biologic activity.”
“Structure and biology of stinging insect venom allergens.” by King
TP, Spangfort MD., The Rockefeller University, New York, published in
International Archives of Allergy and Immunology, 2000 Oct;  Volume
123(no. 2) pp. 99-106.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11060481&dopt=Abstract

What the above extract is saying is that vespids have similar
substances in their venom, so if you are allergic to one of these
insects, you will most likely be allergic to the others.  On the other
hand, there is only one substance that is common to bees and vespids. 
People who have become sensitized to this one substance will probably
be allergic to both bee and wasp stings, but those sensitized to
another wasp venom component will not necessarily be allergic to bee
stings at all.

Here is a study that looked at wasp and bee allergies in the same
individuals and found that it was not possible to predict
cross-reactivity from the previous history of the individual.

“Double sensitization to honeybee (Apis mellifera) and wasp venom
(Vespula spp.) as determined by skin test and measurement of specific
IgE is common in hymenoptera sting allergy. Double-sensitized patients
have either distinct antibodies for each venom or cross-reacting
antibodies that recognize similar or identical epitopes in both
venoms.
….  we investigated 24 double-sensitized patients who were candidates
for venom immunotherapy
…..  Sera of 4 patients were completely cross-reacting for one venom
(3 honeybee, 1 wasp), 8 patients were partially cross-reacting and 10
patients were not cross-reacting. Two patients were excluded from the
study due to insufficient homologous inhibition. Data from specific
IgE measurements, skin test, and clinical history were not useful for
the identification of cross-reacting patients.”
“Double sensitization to honeybee and wasp venom: immunotherapy with
one or with both venoms? Value of FEIA inhibition for the
identification of the cross-reacting ige antibodies in
double-sensitized patients to honeybee and wasp venom.” by Straumann
F, Bucher C, Wuthrich B.
Allergy Unit, Department of Dermatology, University Hospital, Zurich,
Switzerland.  Published in  International Archives of Allergy and
Immunology, 2000 Nov; Volume123(no. 3) pp. 268-74.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11112864&dopt=Abstract

There is also the question of whether someone who is allergic to
anything at all is more likely to become allergic to other things. 
Here there does not seem to be agreement:

This study says yes, that can be the case:
“In a total of 525 patients with hypersensitivity reactions to
hymenoptera stings diagnostic parameters of hymenoptera venom (HV)
allergy (severity of reactions, skin test threshold and RAST for bee
and vespid venoms) were investigated for their relationship to the
following indicators of atopy: positive history of atopic diseases,
elevated (less than or equal to 100 kU/l) total serum IgE and positive
prick test reactions to common inhalant allergens (CIA) (grass pollen,
cat epithelium, house dust mite). There was a conclusive history of
atopic disease in 25%, a total serum IgE greater than or equal to 100
kU/l in 48%, and at least one positive reaction to CIA in 53%.
….. Thus, reactivity to HV in diagnostic tests is increased in the
presence of certain indicators of atopy.”
“Association of features of atopy and diagnostic parameters in
hymenoptera venom allergy. by
Przybilla B, Ring J, Grieshammer B., Dermatologische Klinik,
Ludwig-Maximilians-Universitat Munchen, Germany. Published in Allergy.
1991 Nov; Volume 46(no. 8)  pp 570-6.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1789397&dopt=Abstract

while this one says no:
The patient group in this study consisted of people with anaphylactic
(whole-body) reactions to wasp stings, while the controls were people
who had never shown such reactions.
“The protocol included a standardized questionnaire about symptoms
suggestive of atopy, i.e. medical diagnosis of asthma, perennial
rhinitis or hay fever, and skin tests to common aeroallergens, i.e.
house dust mites, cat danders, and grass pollens. The percentage of
subjects with atopic symptoms was comparable in the two groups (32.2%
for the patient group and 28.5% for the control group). Similarly,
22.6% of patients and 36.8% of controls exhibited at least one
positive skin prick test. Lastly, 15.1% of patients and 18.5% of
controls (a nonsignificant difference) had at least one symptom of
atopy and at least one positive skin test. These findings show that
atopy is not a risk factor for systemic reactions to hymenoptera
stings.”
“Atopy and systemic reactions to hymenoptera stings.” by Birnbaum J,
Vervloet D, Charpin D., Department of Chest Diseases and Allergy,
Hopital Sainte-Marguerite, Marseille, France.
Allergy Proceedings, 1994 Mar-Apr; Volume 15(no. 2)  pp. 49-52.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8034186&dopt=Abstract

If you are at all concerned, you can ask for your daughter to be
tested for sensitivity to insect stings.

I hope that this answers your query to your satisfaction.  Please
request further clarification if required.

Search strategy

The starting point was my own knowledge of immunology, in which I am
qualified to PhD level.  I searched Google and Medline (medical
journal database) for the following:

1. cross-reactivity wasp bee  2. mosquito “saliva contains”  3. atopy
insect stings

---

Clarification of Answer by tehuti-ga on 23 Sep 2003 15:05 PDT

Hello dlenef, with respect to the comments made below, I was working
on the assumption that your query did not require any consideration of
the reaction to mosquito bites as such, so did not discuss this except
to explain why it would not predict whether or not your daughter would
react to a wasp or bee sting.

There is a chance that the yellow jacket sting could have sensitized
your daughter so she reacts to future wasp (and perhaps also bee)
stings. A study has found that of people who become sensitized after a
bee sting as shown in skin tests, about 17% will actually show a
systemic reaction to a subsequent sting. In the others, the
sensitivity will gradually decrease and disappear over the following
years.
"Natural history of Hymenoptera venom sensitivity in adults."
Golden DB, Marsh DG, Freidhoff LR, Kwiterovich KA, Addison B,
Kagey-Sobotka A, Lichtenstein LM.
Johns Hopkins University Asthma and Allergy Center, Baltimore
J Allergy Clin Immunol. 1997 Dec;100(6 Pt 1):760-6. 
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9438483&dopt=Abstract

Well everything above is nice to know and great background, it may not
meet the practical needs of the asker.  As a pediatrician who deals
with questions such as this on a semi-regular basis what I would want
to know is this:  Is the risk of significant allergic reactions high
enough to warrant special treatment such as carrying an epi pen for
immediate treatment of reaction, etc?  It depends on the type of
reaction to the mosquito bites.  Some children have very significant
local reactions at the site of the bite, but very rarely is there any
sort of systemic hives or life-threatening reactions that would
require carrying emergency medications.  These are much more common
with stinging insects including bees, vespids and fire ants.  If this
child did have such a severe reaction to mosquito bites, including low
blood pressure or difficulty breathing, then the epi pen would be
needed anyway, regardless of risk from bee or other stings.  If it is
primarily a local reaction, then that would not be necessary.  The
mosquito bite probably does not put her at increased risk for bee
sting allergies compared to the general population, although if she is
someone who has a lot of allergies to a number of different things
then she might be at somewhat higher risk.  And, as stated above, lack
of reaction to one sting does not mean she will never have more severe
reactions.  Bottom line, if you were seeing me in clinic and had a
severe local (non systemic, non-life threatening) reaction to the
mosquito bites, I would not be overly concerned about allergies to bee
stings.