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Background: Severe systemic reactions (SRs) to insect ven-om are rare in childhood and there are few data on this study population. The aim of our study is to analyze the clinical fea-tures and to document the risk factors for severe SRs in chil-dren with insect venom allergy. Methods: Children with SRs after Hymenoptera sting were analyzed. The diagnosis was based on medical history, skin tests and/or specific IgE test-ing. Results: Seventy-six children were included [57 boys (75%), mean age 9.8 ± 3.4 years]. The mean age of children atthe time of SR was 8.3 ± 3.4 years. Reactions were account-ed for Vespula (wasp) venom in 58 (76%) and Apis mellifera (bee) venom in 18 (24%) patients. Twenty-six percent of pa-tients had aeroallergen sensitization and 33% had atopic dis-ease, whereas 66% had experienced previous stings. The up-per limb was the most frequent area of sting (43%), and the cutaneous system (99%) was the most frequent involved sys-tem. SRs occurred in 59% of patients. Multivariate logistic re-gression analysis revealed eosinophilia (>5%) [odds ratio (OR) 12.6; confidence interval (CI) 1.5-109.7; p = 0.022], female sex (OR 6.4; CI 1.5-26.9; p = 0.011) and accompanying atopic dis-ease (OR 3.4; CI 1.2-12.3; p = 0.016) as significant risk factors for severe SRs. Ninety-seven percent of patients were admit-ted to the emergency department; however, epinephrine was used in only 46% of patients. Conclusions: There was a high frequency of hypersensitivity to wasp venom among the study population, and severe reactions were related to mild eosinophilia, female sex and concomitant atopic diseas-es. A better understanding of the risk factors may lead to ef-fective utilization of health care sources in the future. [ABSTRACT FROM AUTHOR]