Stinging Insect Allergies
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What reactions do insect stings cause?
There are three major types of reactions that can occur from insect stings.
What insects are associated with allergic reactions?
Insects that can cause allergic reactions are classified in what is called the order Hymenoptera. They include the Honey Bee,
Yellow Jacket, Wasp, Yellow Hornet, White-faced Hornet, and Fire Ant.
How common are allergic reactions to stinging insects?
About 3% of adults and 1% of children are allergic to insects. It is the second most common cause of allergic reactions in the
united states (#1 being food allergies). About 40-100 Americans die from insect stings every year.
How are insect stings treated?
If stung by an insect, try to remain calm and brush the insect away. Bees often leave their stinger with a venom sack attached
into the skin, which will continue to release venom for about a minute. You should remove the stinger by scraping it off with
your fingernails or a credit card. Avoid using tweezers as squeezing the stinger can release more venom into the body.
Wasps, yellow jackets, and hornets usually do not leave their stingers in the skin.
Local reactions can be treated with a cold moist cloth or an ice pack. Rubbing the area with a mixture of 3 teaspoons of
baking soda and 1 teaspoon of water is sometimes helpful. Calamine lotion or hydrocortisone cream can also help reduce the
swelling and itching. When large local reactions are severe, doctors sometimes prescribe steroids to help reduce the
inflammation.
Fire ant stings often result in a very itchy bump that turns into a blister about 24 hours after a sting. This blister often contains
a whitish substance that looks like pus…but it is not pus. Although it is very hard to do so, it is best to leave these blisters
alone as breaking them open can lead to severe skin infections. Left alone (and clean), these blisters heal on their own in
about a week.
Allergic reactions require immediate treatment. If you have an epinephrine auto-injector (Epipen or Twinject), use it
immediately then call 911. If you do not have an epinephrine auto injector, seek care immediately by dialing 911.
If you have an insect allergy, you should get a medic alert bracelet and have it inscribed with your allergies. Remember to
always wear it. You can get medic alert bracelets from various places including MedicAlert, 911medalert, and American
Medical ID.
How can I minimize the risk of getting stung?
Essentially, don’t dress or smell like a flower. Avoid bright colorful clothing and perfumes. Dark clothing is best. Avoid
loose fitting clothing which can trap insects between the skin and the clothing. Avoid going outdoors barefoot or with open-
toe shoes. Do not disturb bee hives or other nests. Keep food, drinks, and garbage tightly covered. Unfortunately,
DEET does not work for insects such as honey bees, wasps, yellow jackets, hornets, and fire ants. If you encounter a flying
insect, stay calm and slowly move away – do not swat at them.
Is there a way to prevent large local reactions or allergic reactions if I get stung again?
Definitely! Allergy shots have been developed to help reduce the risk of allergic reactions in people allergic to honey bees,
wasps, yellow jackets, hornets, and fire ants. With allergy shots (venom immunotherapy), gradually stronger doses of
venom extracts are administered over a few weeks or months until a dose equivalent to 2 insect stings is achived. Once this
dose is achieved, it is administered about once every 4-6 weeks for several years. This form of treatment is very effective
and has been shown to help prevent future allergic reactions in 97% of treated patients. They have also been demonstrated to
reduce the size of large local reactions. Thus, not only is venom immunotherapy potentially life saving, but it also greatly
improves quality of life in several ways. First, people with insect allergies often avoid the outdoors due to fears of getting
stung - outdoor activities can again be enjoyed without constantly worrying they will get stung. Second, individuals with
severe large local reactions will see a dramatic reduction in their swelling, pain, and disability. Everyone, regardless of age,
who has suffered an allergic reaction to insects, should be evaluated by a board certified allergist to determine whether it is an
allergy (this is done by doing a skin test) and see if they are a candidate for allergy shots (venom immunotherapy).
Updated 14 Jan 2010
References include
M. Bilo, F Bonafazi. The natural history and epidemiology of insect venom allergy: clinical implications. Clinical &
Experimental Allergy 2009;39:1467-1476
Golden et al. Venom Immunotherapy reduces large local reactions to insect stings. J Allergy Clin Immunol 2009;123:1371-5.
There are three major types of reactions that can occur from insect stings.
- Local reaction: mild redness, swelling and itching at the sting site, which lasts up to several days.
- Large local reactions: these reactions, which develop in up to 20% of insect stings, result in a large area of swelling
which increases in size over 24-48 hours and can last up to a week. The area can affect an entire limb and is often hot
and painful to the touch. When it affects the arm or leg, it may be so painful as to cause difficulties writing or walking.
These reactions are often mistaken for a skin infection. - Allergic reaction: these reactions, also called anaphylaxis, can be very severe and life threatening. Symptoms can
include body itching, hives, swelling of the tongue or throat, difficulties breathing, abdominal cramping, diarrhea,
lightheadedness, loss of consciousness, and even death.
What insects are associated with allergic reactions?
Insects that can cause allergic reactions are classified in what is called the order Hymenoptera. They include the Honey Bee,
Yellow Jacket, Wasp, Yellow Hornet, White-faced Hornet, and Fire Ant.
How common are allergic reactions to stinging insects?
About 3% of adults and 1% of children are allergic to insects. It is the second most common cause of allergic reactions in the
united states (#1 being food allergies). About 40-100 Americans die from insect stings every year.
How are insect stings treated?
If stung by an insect, try to remain calm and brush the insect away. Bees often leave their stinger with a venom sack attached
into the skin, which will continue to release venom for about a minute. You should remove the stinger by scraping it off with
your fingernails or a credit card. Avoid using tweezers as squeezing the stinger can release more venom into the body.
Wasps, yellow jackets, and hornets usually do not leave their stingers in the skin.
Local reactions can be treated with a cold moist cloth or an ice pack. Rubbing the area with a mixture of 3 teaspoons of
baking soda and 1 teaspoon of water is sometimes helpful. Calamine lotion or hydrocortisone cream can also help reduce the
swelling and itching. When large local reactions are severe, doctors sometimes prescribe steroids to help reduce the
inflammation.
Fire ant stings often result in a very itchy bump that turns into a blister about 24 hours after a sting. This blister often contains
a whitish substance that looks like pus…but it is not pus. Although it is very hard to do so, it is best to leave these blisters
alone as breaking them open can lead to severe skin infections. Left alone (and clean), these blisters heal on their own in
about a week.
Allergic reactions require immediate treatment. If you have an epinephrine auto-injector (Epipen or Twinject), use it
immediately then call 911. If you do not have an epinephrine auto injector, seek care immediately by dialing 911.
If you have an insect allergy, you should get a medic alert bracelet and have it inscribed with your allergies. Remember to
always wear it. You can get medic alert bracelets from various places including MedicAlert, 911medalert, and American
Medical ID.
How can I minimize the risk of getting stung?
Essentially, don’t dress or smell like a flower. Avoid bright colorful clothing and perfumes. Dark clothing is best. Avoid
loose fitting clothing which can trap insects between the skin and the clothing. Avoid going outdoors barefoot or with open-
toe shoes. Do not disturb bee hives or other nests. Keep food, drinks, and garbage tightly covered. Unfortunately,
DEET does not work for insects such as honey bees, wasps, yellow jackets, hornets, and fire ants. If you encounter a flying
insect, stay calm and slowly move away – do not swat at them.
Is there a way to prevent large local reactions or allergic reactions if I get stung again?
Definitely! Allergy shots have been developed to help reduce the risk of allergic reactions in people allergic to honey bees,
wasps, yellow jackets, hornets, and fire ants. With allergy shots (venom immunotherapy), gradually stronger doses of
venom extracts are administered over a few weeks or months until a dose equivalent to 2 insect stings is achived. Once this
dose is achieved, it is administered about once every 4-6 weeks for several years. This form of treatment is very effective
and has been shown to help prevent future allergic reactions in 97% of treated patients. They have also been demonstrated to
reduce the size of large local reactions. Thus, not only is venom immunotherapy potentially life saving, but it also greatly
improves quality of life in several ways. First, people with insect allergies often avoid the outdoors due to fears of getting
stung - outdoor activities can again be enjoyed without constantly worrying they will get stung. Second, individuals with
severe large local reactions will see a dramatic reduction in their swelling, pain, and disability. Everyone, regardless of age,
who has suffered an allergic reaction to insects, should be evaluated by a board certified allergist to determine whether it is an
allergy (this is done by doing a skin test) and see if they are a candidate for allergy shots (venom immunotherapy).
Updated 14 Jan 2010
References include
M. Bilo, F Bonafazi. The natural history and epidemiology of insect venom allergy: clinical implications. Clinical &
Experimental Allergy 2009;39:1467-1476
Golden et al. Venom Immunotherapy reduces large local reactions to insect stings. J Allergy Clin Immunol 2009;123:1371-5.
Insect Sting Allergies
Yellow Jacket
Yellow Hornet
Honey Bee
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