Killer Insects: Who Is at Risk for Anaphylaxis From Insect Stings?

Abstract

Patients who have had an anaphylactic reaction to stinging insect should be educated on the potential of fatality from venom allergy. These patients should be referred to an allergist/immunologist, a specialist with training in the diagnosis and management of stinging insect allergy. The three tenets of treatment for stinging insect allergy are insect avoidance measures, proper use of epinephrine, and insect immunotherapy. Avoidance is ideal but not always practical. Intramuscular epinephrine is the only effective therapy for anaphylaxis. Insect immunotherapy is proven to reduce the probability of anaphylaxis with repeat stings from approximately 60 % to less than 5 %. This reduction is not only potentially life-saving but also improves quality of life and reduces anxiety. Before starting immunotherapy, clinicians should have a discussion with patients regarding their goals of care, disease-specific anxiety level, comorbid conditions, and possible compliance issues.