Stinging insects belong in the order of Hymenoptera of the class Insecta. There are two classes that we are concerned about. One is the vespid family, which includes yellow jackets, hornets, and wasps. The other is the apid family which includes the honeybees and bumble bees. A person can be allergic to one insect or many of them. It is important to know which insect(s) can cause a serious reaction, in order to protect yourself and to be prepared to treat an anaphylactic reaction.
Reaction to stings can range from mild redness and pain to serious problems with a drop in blood pressure, difficulty breathing and possible death. The incidence of a serious reaction ranges from 0.4% to 3%. Most serious reactions occur within fifteen minutes. There can be flushing, hives, angioedema (see section on angioedema), edema of the throat, trachea, chest tightness, asthma flare-ups, or a drop in blood pressure.
If someone has suffered a serious reaction in the past, there is a 70% chance that another sting can cause another serious reaction. The second life threatening reaction is generally similar to the first reaction.
Who is at risk?
If you have been stung in the past and only had a local reaction, there is little need to worry. If you have been stung and had trouble breathing, suffered a drop in blood pressure, or experienced swelling of the tongue or throat, you should see an allergist for evaluation and possible immunotherapy injections to prevent a serious recurrence.
Some patients have suffered with a large quantity of hives, or welts throughout the body or swelling of different areas of the face. These patients may also be candidates to suffer a serious reaction.
Avoiding a sting is important, whether you are allergic or not. Wear white or light colored clothing, avoid bright colors, avoid perfumes or deodorant that has a fragrance. Food odors may attract the insects. Wear long pants and shoes when outdoors. Location of the insect is important, avoid piles of debris, trash bins, trails that are rarely traveled, observe for nests in overhangs, gutters, and in shrubs. Watch and take care where you walk or step (most stings come from the yellow jacket, they nest in the ground).
Treating Insect Allergy Stings
A local reaction or generalized reaction can be treated with an oral antihistamine like Diphenhydramine (Benadryl®). If you have had larger or more serious previous reactions, you may have prednisone available (only available by prescription). If the reaction is progressing, you should seek help in the emergency room or contact 911. You should carry epinephrine with you at all times if you have experienced a previous life-threatening reaction. Most people with stinging insect allergies carry epinephrine in the form of an Epi-pen® when outdoors. If a reaction is serious, you may need to use the Epi-pen® and seek medical help.
Placing creams and ointments on the skin may help soothe the area, but nothing will stop the reaction like an oral antihistamine.
If you have suffered a life threatening reaction, you should see an allergist who can skin test you and determine your reaction to different stinging insects. If your skin test results are positive, you may be a candidate for immunotherapy (allergy injections). This will help protect you from another serious reaction. The injections are first given weekly and then rapidly spread out to once every six weeks. After five years, most individuals are done with their injections. Sometimes an allergist will offer Rush Immunotherapy: you will receive many injections in one day and you will not need to return weekly for the build up phase.
Carrying Epi-pens® are very important for anyone who has suffered a life threatening reaction.
An allergist is trained to treat and manage insect stings. If you have had a serious reaction you should see an allergist to discuss your reaction to the insect sting.
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