Hymenoptera venom allergy (HVA) is a common emergency encountered in clinical practice. Many older adult patients engage in gardening or light agricultural work during stings. Younger patients are more likely to be stung during outdoor recreational activities, such as jogging or hiking.

While most patients with HVAs are discharged after treatment in the emergency department, a small percentage require hospitalization due to systemic reactions (SRs). Most patients with HVAs receive wound care, tetanus toxoid injections, antihistamines, and anti-inflammatory agents and are discharged from the emergency department. A British study reported that beekeepers have a notably higher incidence of SRs, ranging from 21 % to 42 %, than the general population [[1], [2], [3]]. In contrast, studies from Spain and Switzerland have reported lower SR rates, ranging from 2.3 % to 12.5 % [[4], [5], [6]].

Some studies have shown that the severity of systemic HVAs does not differ significantly between older and younger adult patients [7]. Therefore, understanding how age-related physiological changes exacerbate venom-induced anaphylaxis and cardiovascular symptoms is crucial for managing older adults. Although the overall severity of SRs may not differ significantly between younger and older adults, cardiovascular complications tend to worsen with age, especially in the aging structural society of some Asian countries. This highlights the importance of promptly identifying and managing cardiovascular symptoms in older adult patients with HVAs, particularly those with multiple risk factors for severe anaphylaxis.

Several studies have focused on Hymenoptera stings in older adult populations; however, few have specifically examined the relationship between sting locations, number of stings, and need for hospitalization. Our study aimed to identify the factors leading to hospitalization due to HVAs, offering valuable insights for clinicians to prevent HVAs.

This study addresses a gap in the existing research by investigating both allergic and non-allergic SRs to Hymenoptera stings, particularly in older adult patients. While prior studies have predominantly focused on allergic responses, SRs can also include toxic and cardiovascular effects, which may be more pronounced in older adults than in younger adults. This study aimed to identify the risk factors for severe HVA reactions and hospitalization, focusing on older adult patients who are more vulnerable owing to age-related immune and cardiovascular changes. Variables such as the number and location of stings, baseline serum tryptase (BST) levels, and heart rate were examined to better understand the impact of these factors on the patient outcomes. Highlighting these non-allergic factors helps in understanding the broader risks associated with Hymenoptera stings in older adults.