Background: Severity of allergic reactions to bee venoms may depend on the degree of previous sting reactions. Tests for venom-specific IgE antibodies are frequently positive in patients with allergic sting reactions. Objective: We studied the clinical significance of preceding reactions and serum-specific IgE antibodies in patients with bee sting anaphylaxis. Method: Nine patients with bee sting anaphylaxis were included. Details in the current anaphylaxis and previous reactions were retrospectively obtained. Venom-specific IgE antibodies were measured by using ImmunoCAP in 6 patients. Result: Seven (78%) of 9 patients had preceding reactions. Details in the reactions were available in 5 patients who were stung by the same bee or family as the current stings. Four (80%) patients of these 5 patients had experienced only large local reactions or systemic cutaneous reactions from the preceding stings. With regard to specific IgE antibodies, 2 (33%) of the 6 patients were negative for the same venoms as in the preceding stings. Conclusion: Bee venom-induced anaphylaxis can occur although preceding reactions are local or mild systemic ones. Tests for venom-specific IgE antibodies can be negative in patients with bee sting anaphylaxis