Massive European wasp envenomation of a child

AbstractEnvenomation is a unique area of emergency medicine which interfaces acute emergency care with zoological research and public education. A considerable amount is known about envenomation by the snakes and spiders of Australia, which are among the most venomous in the world. There is little known, however, about massive envenomation by the European wasp (species Vespula germanica, family Vespidae), a recently introduced, aggressive and venomous vespid wasp. Allergy to bee, wasp and ant venom (order Hymenoptera) is well reported in the literature but there has been no documentation of systemic allergic reactions following massive vespid envenomation. Massive envenomation by vespid wasps in Australia has not been reported, although there are international reports of serious morbidity and a number of fatalities. This paper reports a massive European wasp envenomation in Melbourne and reviews the international literature. In this case, in contrast to the literature on massive vespid wasp envenomation, there is predominance of central nervous system toxicity with no major metabolic disturbance. The management of massive vespid envenomation includes standard supportive care and close laboratory monitoring for early evidence of haemolysis, rhabdomyolysis and metabolic derangement, which may significantly precede any clinical deterioration. Serious complications may be delayed and it is advised to follow up patients for 72 hours. There is potential for further research into vespid wasp venom and a need for increased public awareness of preventative strategies in Australia.