Clinical reactivity to insect stings

Abstract

Allergy to insect stings remains a hazard worldwide and is the object of updated guidelines on management. This paper reviews the various clinical responses that may occur following an insect sting. Although the general population is at slight risk, certain groups are more susceptible, including occasionally stung adult male agricultural workers, hobby honey beekeepers and family members of beekeepers. Individuals with systemic mastocytosis are especially reactive to stings. The body of evidence attesting to the marked beneficial effect that 3-5 years of venom immunotherapy has on the natural history of hymenoptera hypersensitivity is especially evident in children. Case reports indicate other consequences of hymenoptera sting, and these are discussed. Hypersensitivity to insect stings is common and may be life threatening. Although most occur away from medical facilities, their diagnosis and management are important to a wide spectrum of health care professionals. Most reactions to stings are nonallergic manifestations of the venom's toxic effects, and present as erythema, pain and swelling about the sting site. Fire ants bite with their mandibles and pivot their head, inflicting multiple stings that usually result in a sterile pseudopustule at the site. Hypersensitivity responses to venom range from large local reactions (a late-phase response) to life-threatening anaphylaxis. Venom-specific immunotherapy is highly effective in the modification of subsequent reactions to hymenoptera stings, as is whole body extract for fire ant stings.