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Stinging Insect Allergy
reactions to stinging insects can be life threatening. Over 40 people in the US
each year die as a result of insect stings. Thousands more are treated in the
ERs and admitted to ICU units following a life threatening SYSTEMIC reaction to
a stinging insect.
The family of
insects responsible for these allergic reactions in susceptible individuals are
called “Hymenoptera”. They all produce a venom composed of multiple
ingredients, and include hornets, wasps, yellow jackets, honey bees, and even
fire ants (in the Southern US, including Florida.) The venom is fairly specific
for each type of stinging insect---therefore most individuals are allergic to
only one or two different types. There is some cross reactivity between some
species, however, and testing for stinging insect allergy in the office may
reveal an allergy to more that one type of insect.
the most common flying stinging insect, but not necessarily the most
aggressive. There are the only ones that are capable of stinging only once, as
their stinger eviscerates from their body when they pull away from the host
after a sting, and they die shortly thereafter. A sting left in your skin after
a sting is a sure sign that it was from a honey bee. DO NOT hold the stinger
between your fingers when you remove it from your body, as this may inject more
venom into your skin---simply flick it off with your fingertip, or carefully
remove it from the base with tweezers. Paper wasps make their honeycomb
type “paper” nests in the eaves of a roof or entryway. Hornets build big
round or oval nests that often hang from trees, and yellow jackets build
their nests in old logs or in the ground. Yellow jackets especially love sweet
juices like soda, and are therefore found in picnic grounds and near garbage
ants come in all colors and sizes.
Just because they are not red does not mean that they are not “FIRE” ants or do
not have venom!! Treating the ground around your home may keep them away for
several months, but if your neighbor does not also treat their lawn, they will
migrate next door, then return to your lot when your neighbor treats his lot!
Have someone who is not allergic to fire ants treat the mounds and about three
to four feet all the way around the mound. Always were footgear when outside,
especially on a field or lawn, and always look down when you stop to talk or do
something. A reaction to a single fire ant bite can be just as life threatening
as a wasp sting if that person has a strong sensitivity to the fire ant venom!
stinging insects can be LOCAL or SYSTEMIC. Local reactions can be very
large (several inches), itchy, sore and swollen, even for days, but are generally
not life threatening (unless located possibly on the tongue or the neck), and do
not need further testing or evaluation by an allergist. It is best to apply ice
immediately, for ten to fifteen minutes at a time, a few times daily in the
first 24 hours, for swelling, and take an antihistamine as soon as possible.
Over the counter Claritin may be helpful, and is non-drowsy, but Benadryl (diphenhydramine)
or Tavist will work more quickly, and for many seem more effective. Be aware of
the potential for drowsiness with these latter two meds.
consist of symptoms away from the site of the sting, such as a body rash or
itchy raised hives, feeling of warmth all over, cough, wheeze, lightheadedness or
nausea. Urgent care is necessary, and immediate medical attention must be
given! The best treatment is adrenaline (epinephrine) administered by
injection, either subcutaneously (in the fat), or IM (in the muscle),
preferably. ALL PATIENTS WITH A PREVIOUS SYSTEMIC REACTION TO A STINGING INSECT
MUST HAVE ADRENALINE (EPINEPHRINE, IE EPI-PEN), ON HAND AT ALL TIMES IN CASE OF
THE LIKELY (50-60%) CHANCE OF ANOTHER SYSTEMIC REACTION WITH THE NEXT STING!!!
We can evaluate
all patients with a prior systemic reaction for stinging insect allergy in our
allergy office during a 1-2 hour skin test. It is very easily done, and
available for patients of all ages. The test will show to which insects they
are allergic, and how severe the allergy is. If found to be positive, they
should seriously consider a course of allergy injections (immunotherapy) to
prevent a future systemic reaction to a sting. We have NEVER had a patient
experience a systemic reaction upon a re-sting after reaching a maintenance dose
to venom immunotherapy using our protocol! In studies across the nation, this
regimen is about 98% effective.
precautions for all those individuals allergic to stinging insects are:
Do not wear
bright clothing outdoors---The insects are attracted to bright
colors---khaki or white colors are best.
antagonize a stinging insect. Most will sting only when disturbed suddenly.
around old logs, tires, and garbage cans; always watch where you are walking
for fire ants, and yellow jackets and honeybees on the lawn.
Watch for and
treat your lawn for fire ant mounds regularly.
“long distance” type sprays to kill wasp nests, etc., and have someone who
is not known to be allergic, use those sprays.
precautions will help to reduce risk of a sting. If you have any further
questions, or need an evaluation, please call our office for an appointment.
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