Insect Allergy: A Review of Diagnosis and Treatment

Abstract

Insect allergy is the third most common cause of the life-threatening condition anaphylaxis, following food and medications. Insect allergy anaphylaxis poses risk of considerable morbidity and mortality. Avoidance of the offending agent is the cornerstone to the management anaphylaxis regardless of the cause. However, unlike food and medication allergy, insect allergy has been effectively treated, using well-established protocols for many years. Hymenoptera are the insects most associated with allergy and anaphylaxis with at least 40 deaths per year attributed to insect stings in the United States. It is critical that healthcare professionals and the public understand the proper diagnosis as well as the long-term treatment of this potentially life-threatening allergy. Insect allergy from Hymenoptera, managed prospectively using venom immunotherapy, conveys up to 98% protection of anaphylaxis with future stings. Insects of the order Hymenoptera include bees, wasps, hornets, yellow jackets, and stinging ants. Stinging ant allergy will not be reviewed in this chapter. An understanding of the biology and habitat of the various Hymenoptera species is helpful in recommending insect avoidance strategies. The diagnosis of insect allergy relies on a history of a systemic allergic reaction followed by appropriate testing for venom-specific IgE. If the history of a generalized anaphylactic reaction to an insect sting and the presence of venom-specific IgE are confirmed, venom immunotherapy is indicated. It is venom immunotherapy, a disease modifying therapy, that provides the most effective protection against future sting reactions. Ultimately, recognition and lifesaving management is critical. Subsequently, evaluation and potentially long-term management of insect allergy include appropriate referral to an allergist familiar with insect allergy and, if indicated, venom immunotherapy.