Stinging Insect Hypersensitivity

Abstract

Most reactions to insect stings are local, short-lived, and resolve spontaneously. Hypersensitivity reactions include large local reactions (LLRs), systemic cutaneous reactions, and systemic reactions (anaphylaxis). Venom hypersensitivity is a well-known cause of anaphylaxis that may be fatal. Mastocytosis occurs in about 2% of patients with insect sting anaphylaxis, and insect sting anaphylaxis occurs in approximately 25% of patients with mastocytosis. Stinging insect families of the order of Hymenoptera that can cause hypersensitivity reactions include Apidae (honeybee and bumblebee), Vespidae (yellow jacket, yellow hornet, white-faced hornet, and paper wasp), and Formicidae (imported fire ants). Diagnosis requires a thorough clinical history to characterize the reaction type and severity as well as relevant clinical factors to determine the need for venom allergen testing and possibly venom immunotherapy (VIT). Non-pharmacologic management includes patient education on stinging insect avoidance measures and cold compresses for local reactions. Pharmacologic management depends on the reaction type. For local reactions and LLRs, analgesics and antihistamines may be used, and oral corticosteroids used for LLRs and antibiotics for superimposed bacterial infection. Epinephrine auto-injector, anaphylaxis action plan, and a MedicAlert™ bracelet are provided for those diagnosed with systemic reactions. VIT is offered as a long-term management option if indicated.