Recognition, Management, and Prevention of Hymenopteran Stings and Allergic Reactions in Travelers

Abstract

Allergic reactions to insect bites and stings remain exceedingly common indications for urgent health care visits worldwide. Estimates of the worldwide annual incidence of immunologic reactions to hymenopteran stings in the world population range from 0.3% to 3.0% or nearly 100 million cases per year ranging from local wheal‐and‐flare reactions to deaths from anaphylactic shock.1–4 In the United States, the annual incidence of allergic reactions to hymenopteran stings ranges between 0.4% and 4.0%, with 40 to 50 deaths a year.1–6 These allergic reactions are mediated by immunoglobulins that target specific antigens in hymenopteran venoms.5 Hymenopterans are, therefore, among the most medically important arthropods, responsible for most cases of hypersensitivity reactions to insect stings.2–8 This article will review the descriptive epidemiology of hymenopteran stings and allergic reactions, risk stratified by severity and outcomes. In addition, this article will review current recommendations for the clinical assessment and management, immunoprophylaxis, and prevention of hymenopteran stings and allergic reactions in travelers. ### The Taxonomy of Hymenopterans The current taxonomy of the medically important hymenopterans is depicted in Table 1. View this table: Table 1 The taxonomy of hymenopterans (phylum: Arthropoda, class: Insecta, and order: Hymenoptera) ### The Mechanisms of Hymenopteran Envenoming Apids or bees inflict single stings as their stingers deeply embed in victims and detach in contiguity with the distal ends of their abdomens, whereas vespids or wasps often inflict multiple stings with stingers that have few barbs and can be easily withdrawn, usually without detaching. Formicids or ants first anchor to their victims by biting, then pivot around the bite site, stinging repeatedly in a circular pattern with modified ovipositors similar to vespid stingers. ### The Toxicology of Hymenopteran Venoms In general, hymenopteran venoms all exhibit the following physiochemical characteristics: (1) acidic, proteinaceous liquids with an aromatic odor and a sharp, bitter taste; (2) a slightly yellowish color; and (3) a dried residue also with a slightly yellowish color … Corresponding Author: James H. Diaz, MD, MPH&TM, DrPH, Department of Anesthesiology, School of Medicine, Louisiana State University Health Sciences Center in New Orleans, 1615 Poydras Street, Suite 1400, New Orleans, LA 70112, USA. E‐mail: jdiaz{at}lsuhsc.edu