Stinging Insect Allergy

What you should know to keep you safe this summer.

By Tamara S. Smith, M.D., MPH

As the weather warms up and we begin to venture outside, our insect friends are doing the same. Oftentimes the encounter with a stinging insect, such as a bee or a wasp, is inconsequential. Unfortunately, sometimes the interaction results in a sting which may or may not become dangerous.

Most people are not allergic to insect stings, but for those who are, these reactions can be severe. It is estimated that potential life-threatening allergic reactions occur in 0.5 percent of children and 3 percent of adults. In addition, there are 90 to 100 deaths per year from stinging insect anaphylaxis.

It is important to know the difference between a normal reaction to a sting and one that is life-threatening. Normal reactions can include pain, redness, and swelling at the sting site. While uncomfortable, this may not require any further treatment or evaluation. Large local reactions (swelling extending beyond the sting site; for instance, a sting on a hand results in the whole hand and arm swelling) can also occur and, while they are not life-threatening, oftentimes need medications to relieve pain and swelling.

The most severe reaction is anaphylaxis. This is indicated by a series of signs and symptoms after being stung by a bee, wasp, hornet, yellow jacket, or fire ant that are not local to the sting site. Symptoms of this allergic reaction include itching, hives (also called urticaria), swelling, chest pain or difficulty breathing, hoarse voice or throat swelling, abdominal pain/cramping, dizziness, passing out or nearly passing out, or even cardiac arrest. These kinds of allergic reactions occur within minutes and require immediate medical attention.

After acute medical treatment in the Emergency Room or Urgent Care, a follow-up with a board-certified allergist and immunologist is recommended so that identification of the trigger and discussion of a treatment plan and an appropriate action plan can be developed for each patient. Testing to identify the trigger is typically completed with allergy skin tests and occasionally blood tests. Patients are tested for allergies to each stinging insect because many people are allergic to more than one family of vespids and it is important to identify all of them. Skin tests are simple and completed in the office, which provides immediate results at the initial evaluation. After the triggers are known, the allergist will propose a treatment plan to ideally avoid future systemic reactions.

Recommendations regarding the treatment of stinging insect allergies include ways to avoid stings, such as not wearing open-toed shoes in tall grass, not looking or smelling like a flower (i.e. avoiding perfumes and wearing brightly colored clothing), and keeping food, drinks, and trash cans covered at all times when eating outdoors. All patients with a history of anaphylaxis should carry injectable epinephrine for self-administration; there are several on the market today.

Your allergist should then discuss the long-term treatment of a stinging insect allergy which is venom immunotherapy solution. This program, administered by your allergist, can prevent future allergic reactions to insect stings. It involves injecting increasing amounts of the stinging insect venom into the individual over time to desensitize them.

This desensitization can achieve and sustain tolerance to the point that subsequent exposure may reduce the patient’s risk of an allergic reaction to the level of those in the general population. Patients who were once fearful of going outside or had high anxiety surrounding their venom allergy are able to comfortably go outdoors with little fear, returning them to their usual state of health.

If you think you have had an allergic reaction to a stinging insect or know someone who has, contact your local allergist for evaluation and treatment. Let’s all step outside this summer and enjoy the outdoors with less fear and more freedom.  

Dr. Smith

About the Author:

Tamara S. Smith, M.D., MPH is one of the providers at Family Allergy Center, located at located at 14535 John Marshall Highway (Suite 212) in Gainesville. This family-friendly facility specializes in the diagnosis and treatment of pediatric and adult asthma and allergic and immunologic diseases, with ongoing care of patients throughout their lifetime. To contact them visit their website or call 571-248-0245.

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