Introduction The risk for a beekeeper to become allergic to bee venom is higher than the general population. The possibility that they develop an allergy is greater when rarely bite with 2/3 month interval. On the contrary, when bites are simultaneous or tight over time the probability of allergy decreases. Beekeepers who receive more than 200 stings do not develop venom allergy. In general, subjects developing a reaction limited to the skin have 70% possibility of a spontaneous recovery. On the contrary, people haveing a systemic reaction tends to show the same or greater reaction when restung.
Discussion Work suitability of bee allergic beekeepers, which had a systemic reaction is a relevant problem for occupational doctors. They should be prescribed appropriate DPI and provided of auto-injectable adrenaline as emergency treatment, sure that they received the necessary training. Furthermore, it is desirable that every allergic subject receives a desensitising treatment, as it is efficacious in 95% of patients. The treatment will last for 5 years, except for subjects with high basal tryptase who should be treated for a life-time, as the risk of anaphylaxis reappears after the discontinuation of an already effective immunotherapy. The cardiac involvement during anaphylaxis is very frequent with the picture of Kounis Syndrome (KS), characterised by infarction induced by the effects on coronaries of mast cell chemical mediators. In particular, histamine, usually vasodilator agent, can induce vasoconstriction subjects with coronary endothelial lesions. In this situation, the coronary spasm worsens the perfusion of a tachy heart, already with increased blood demand, with a potentially life-threatening ischemia. Furthermore, in a subject developing a KS the administration of adrenaline should be carefully evaluated as adrenaline, having vasoconstriction effects, can worsen the myocardial ischemia.
Conclusions It is our opinion that work suitability cannot be granted to beekeepers who developed KS with.
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