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Insect Sting Allergy in Adults

  • Anne K. Ellis
  • James H. Day
Part of the Allergy Frontiers book series (ALLERGY, volume 3)

Abstract

Reactions to insect stings vary from a usual small painful swelling at the site to a large local reaction which may involve an entire limb secondary to a late phase allergic response. These alone do not predict future systemic reactions. Systemic reactions, even mild ones are mostly due to specific IgE responses to venom and may be life-threatening. These should be managed immediately and be followed up for possible specific venom immunotherapy (VIT).

Most stings occur away from emergency facilities thus immediate recognition of the event and proper management is essential. Yellow jackets are the main culprits in the general population followed up by honey bees especially among workers in the industry. Other stinging insects include various wasps, hornets, and in southern climates, fire ants. Africanized bees, because of their aggressive nature are a likely source of stings where they occur.

Epinephrine by intramuscular injection is regarded as the treatment of choice for anaphylactic responses followed up by antihistamines alone or in combination with corticosteroids. Auto-injectors of epinephrine should be prescribed and their use is clearly demonstrated under the supervision of a physician or a trained nurse. There is a 20% incidence of second-phase anaphylactic reactivity, and patients need to be warned and monitored for this development.

Patients having systemic reactions should be referred to an Allergy Specialist for evaluation and, if indicated, specific VIT. VIT is usually limited to 3–5 years in most patients with mild to moderate anaphylactic reactions supported by evidence of specific venom allergy, but long term or even life-long treatment may be considered in those whose reaction was particularly severe especially in a setting where future stings are likely. For persons at risk of sting reactions such as agricultural workers, those working in the bee industry and their family members while undergoing VIT, emergency kits containing epinephrine auto-injectors should be reasonably available.

Keywords

Allergy Clin Immunol Hymenoptera Venom Insect Sting Honeybee Venom Yellow Jacket 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer 2009

Authors and Affiliations

  • Anne K. Ellis
    • 1
  • James H. Day
    • 2
  1. 1.Assistant Professor, Division of Allergy and Immunology, Department of Medicine and Department of Microbiology and ImmunologyQueen's University KingstonCanada
  2. 2.Professor and Head, Division of Allergy and Immunology, Department of MedicineQueen's UniversityKingstonCanada

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