462 When Honeybees Attack: Adrenal Insufficiency as a Late Consequence of Massive Exposure

BACKGROUND: Evaluations of massive envenomation events have not commonly shown an increased risk for adrenal insufficiency. METHODS: A 77 year old woman and her 80 year old husband live part of the year in Bolovia where they have kept hives of Africanized honey bees for many years. Neither of them had shown evidence of bee sting hypersensitivity in the past. While tending their hives in a remote area, both were exposed to a massive number of stings (he > 600, she > 200) and barely survived. They are both wondering if they have become sensitized as a result of this event. After discharge from the hospital in Bolivia, she began to experience lethargy and was hospitalized again in Seattle with nausea, vomitting and eosinophilia. Abdominal CT scans showed bilateral adrenal enlargement/masses. Medline, PubMed and Google Scholar searches were performed looking for reports of adrenal insufficiency and bee sting anaphylaxis/exposure. RESULTS: Evaluation showed evidence of adrenal insufficiency and she has responded to replacement therapy. Subsequent abdominal CT scans have shown shrinkage and involution of both adrenal glands. Both husband and wife were evaluated for stinging insect hypersensitivity and found to be allergic only to honey bee venom and have begun desensitization. They intend to continue to keep honey bees in Seattle but not in Bolivia. CONCLUSIONS: A single publication of 3 autopsy studies (Huang, I et al, JACI 1971) looking at venom-specific IgE in tissues showed intense localization in the serum and myocardium in 3 of 3 subjects and adrenal glands in 2 of 3 subjects all of whom died following a single honey bee sting. This would suggest that adrenal insufficiency may be a delayed complication of near-fatal massive envenomation and may play a role in immediate fatal events.