Stinging Insect Allergies
What reactions do insect stings cause?

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 10-20% of insect stings, result in a large area of redness and
    swelling that increase in size over 1-3 days and may last up to a week.   The area can affect an entire limb and is often
    hot and painful to the touch (often mistaken for a skin infection).   When it affects the arm or leg, it may be so painful as
    to cause difficulties writing or walking.  

  • 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.    These reactions can occur within seconds to minutes of an
    insect sting, but can also start to develop 15-45 minutes later.   These reactions can be very severe immediately, or they
    be very mild at first (perhaps just mild hives) then gradually (or quickly) get severe.

What insects are associated with allergic reactions?
Themost common insects which 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 (
Adrenaclick, Epipen , Auvi-Q, 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 are allergic to insect stings:
Always carry your epinephrine auto-injector with you.  Because 1 dose may not be enough, it is recommended that you carry
2 doses with you (1 Twinject , 2 Auvi-Q, 2 adrenaclicks, or 2 Epipens) at all times.

Learn how to use your auto-injector before you have a reaction.  The time to learn is not when you are having symptom!  

Have a plan and teach your family, friends, and co-workers how to use the injectors in case you are not able to administer a
dose yourself.

Don’t assume your friends, child’s teacher, sitter, or caregiver knows how to use an epinephrine auto-injector—go through all
the steps with them.  If you have some expired epinephrine auto-injectors laying around, you can practice using them on an
orange to get a feel of how they really work.

Do not delay in seeking help.   You should always seek emergency treatment (IE. Call 911) when you have an allergic
reaction.

Get a medic alert (you can get medic alert bracelets from various places including
medic alert or American Medical ID) and
don't forget to wear it!  


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 2-4 insect stings is achieved.  Once this dose
is reached, it is administered about once every 4-8 weeks for several years.  This form of treatment  is very effective and has
been shown to help prevent future allergic reactions in 97-98% of treated patients.  They have also been demonstrated to
reduce the size of large local reactions.   Venom immunotherapy is not only a life saving treatment, 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 see if they are a candidate for
allergy shots (venom immunotherapy).


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

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