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To the Editor.—
Dr. Epstein first questions my treatment of localized insect-sting reactions with hyposensitizing injections. In the article, I had emphasized that these were severe localized reactions. It is not a toxic effect when a tiny drop of venom may cause an entire extremity to swell. Also, it is not delayed hypersensitivity when reactions begin within minutes. This seems to be another manifestation of immediate type of hypersensitivity. Some of the patients who later suffered generalized reactions gave a history of having first received large local reactions from Hymenoptera stings. I am a member of the Insect Study Committee of the American Academy of Allergy and have discussed this problem on numerous occasions with other allergists. The consensus is that this type of reaction probably is a manifestation of a true immediate-type hypersensitivity to the stinging insects. I believe that Dr. Epstein has another type of hypersensitivity in mind
Barr SE. Hymenoptera Stings. JAMA. 1974;229(6):637–638. doi:10.1001/jama.1974.03230440013005
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