This review includes a variety of extremely rare and unusual hymenoptera
sting (HS) circumstances with regard to
sting localization, geographic region, massivity of multiple
stings, and particularly related to clinical symptoms. Such reactions occur in a temporal relationship to HS (s), differ from typical allergic symptomatology, and sometimes need follow-up during many months. With respect to pathogenesis, the major mechanisms involved are toxic, autoimmune, and other delayed immunological ones. While delayed inflammatory symptoms of the nervous system are considered as delayed hypersensitization or autoimmune entities, generalized
rhabdomyolysis and consecutive
acute kidney injury is considered a toxic reaction, mostly induced by massive envenomation to wasps or "Africanized" bees. Hemorrhagic episodes of targeted organ (s) could be additional potential risk for
acute kidney injury, while the
bee venom-induced
hemorrhage is proposed to be a nonimmune-mediated anaphylactic symptom. The hemodynamic involvement of vital organs and systems with
hypoxia and
hypovolemia together with simultaneous
immunoglobulin E (
IgE) sensitization are considered potential indications for venom immunotherapy. In contrast, patients who have experienced various complications with unknown or nonallergic mechanisms should be informed about the importance of
epinephrine's use and additional measures on future
sting avoidance. In conclusion, although unusual reactions are extremely rare, it is important to keep them in mind.