About 17% of patients admitted to hospitals after bee stings need mechanical ventilation

Key takeaways:

• Patients on ventilation stayed in the hospital for a mean of 5.45 days.
• Patients on ventilation were more likely to be men and on Medicaid.
• Cirrhosis, obesity and depression were risk factors for ventilation.

BOSTON — Approximately 17% of patients who were admitted to the hospital after a bee sting required mechanical ventilation, according to a study presented at the CHEST Annual Meeting.

Multiple physical and demographic factors were associated with higher odds for ventilation, Jobby John, MBBS, of Dr. Somervell Memorial CSI Medical College and Hospital, Kerala, India, said during his presentation.

“During my training in India, I came across a case of bee venom allergy that resulted in hospitalization and required mechanical ventilation,” John told Healio.

Jobby John

However, he continued, data pertaining to allergic reactions secondary to bee stings, their hospitalization and the need for mechanical ventilation (MV) was lacking in the literature.

“The CDC estimates that around one in three U.S. adults have some form of allergies —seasonal, eczema or food allergy — and the Boston Children’s Hospital estimates that around 2 million Americans are allergic to bee stings, with around 100 deaths annually,” John said.

Although bee stings generally lead to erythema, edema, pain and other local reactions, the researchers wrote, systematic and life-threatening anaphylaxis that may require ventilatory support occurs in 0.3% to 7.5% of cases.

“We therefore tried to explore this topic via the biggest in-patient database,” John said.

Study design, results

The retrospective study reviewed data from 6,085 admissions for adults (61.8% men; 70.6% white) who had “an initial encounter with the toxic effect of bee venom (accidental)” included in the 2016-2020 National Inpatient Sample, which the researchers called the most extensive inpatient database in the U.S.

“The mean age of all patients was 54.9 years, with the highest number of cases seen among patients aged 55 years (180 cases),” John said.

The cohort included 1,060 cases (17.4%) that required MV. Mean ages included 53.37 years for those who required MV and 55.26 years for those who did not (P < .01).

“This was surprising, as I thought the elderly would be more prone to it since aging leads to more significant changes to the airways,” John said.

Also, mean lengths of stay included 5.45 days for those who required MV and 2.54 days for those who did not (P < .01).

“Our study further found that Medicaid-insured patients had higher odds of requiring mechanical ventilation,” John said.

Patients on MV were more likely to be on Medicaid instead of Medicare (aOR = 1.757; 95% CI, 1.361-2.268) and men instead of women (adjusted OR = 1.251; 95% CI, 1.065-1.469)

Also, patients on MV were more likely to have pre-existing cirrhosis (aOR = 2.849; 95% CI, 1.561-5.203), peripheral vascular disease (aOR = 1.895; 95% CI, 1.165-3.083), obesity (aOR = 1.543; 95% CI, 1.289-1.847) and depression (aOR = 1.402; 95% CI, 1.110-1.772).

Patients who were Black were less likely to need MV than patients who were white (aOR = 0.68; 95% CI, 0.531-0.87), but there were no differences between Hispanic patients and white patients.

Mean Charlson Comorbidity Index scores included 1.68 for the patients who needed MV and 1.12 for the patients who did not (P < .01). Additionally, 16% of those on MV and 0.3% of those who were not on MV died (P < .01). The adjusted odds ratio for death among patients on MV was 71.781.

Mean hospital charges included $78,238 for those on MV and $28,823 for those who were not on MV.

Conclusions, next steps

Based on these findings, the researchers concluded that specific pre-existing and demographic factors were associated with the need for MV after hospital admission for bee stings, with poorer short-term outcomes and higher costs.

“Such findings show the potential impact of sex, race, insurance and comorbidities on the progress following the bee sting,” John said.

There may be a link between genetic factors and severity of symptoms following bee stings, he continued, as previous reports have indicated that various single-nucleotide polymorphisms affect allergic reactions.

“However, there is a strong need to explore these further,” John said.

John additionally noted that the NIS does not include data about the severity of these reactions among patients who have been admitted to the hospital.

“We also do not know how many stings they had, the time from the sting to their hospitalization when they required mechanical ventilation and what other treatments were given during their hospitalizations,” he said. “Such findings will help improve our study.”

These findings have implications for care, John continued, showing that comorbidities could impact outcomes and predispose patients to requiring MV.

“Physicians can stratify those with such comorbidities as high risk and monitor them more closely, eg, by checking their oxygen saturation more regularly, inquiring about shortness of breath, or any signs of impending respiratory compromise or distress,” he said.

Patients who have other allergies should be educated about the potential risks for these complications as well, John said.

“However, additional studies are needed to link specific allergies to bee stings,” he said.

Next, John and his colleagues plan on seeking additional feedback from senior experts in the field and eventually converting the project into a manuscript for publication.

“We believe that this project will raise more awareness of this issue,” he said.

For more information:

Jobby John, MBBS, can be reached at dr.jobbyjohn@gmail.com.