Key points

• We found good evidence evaluating oral antihistamines given prophylactically (but only cetirizine and ebastine) versus placebo and little evidence evaluating topical treatment for insect-bite reactions.

• We found no reliable evidence on symptomatic treatment of Hymenoptera stings and only one trial evaluating removing the honeybee sting with pinching versus scraping. Treatment of adverse systemic reactions to insect stings with antihistamines and steroids was reported in case series. Anaphylactic reactions were treated similarly to anaphylactic reactions from other causes.

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