Insect Sting Allergy

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Insect stings can produce significant and sometimes fatal reactions, particularly in sensitized patients. Approximately 100 patients die annually from insect sting reactions, making insect sting the second most common cause of fatal anaphylaxis. True stinging insects belong to the order Hymenoptera, which includes three families: Apoidea (honeybee), Formicoidea (fire ants), and Vespidae (wasps, yellow jackets, and hornets). The venoms of each family are unique, although all have similar types of components, mostly proteins. This difference accounts for the limited cross-reactivity seen. The usual reaction to these stings includes localized pain, pruritus, swelling, and redness. Sensitized individuals may have exaggerated local reactions with or without systemic manifestations. Systemic reactions run from mild nausea and malaise to urticaria, angioedema, or anaphylaxis.

Diagnosis depends on clinical history, with particular attention to past reactions, and an examination to locate the site of the sting. Occasionally, the site of envenomization is overlooked, and predominance of reaction in one organ system can lead to misdiagnosis.

Treatment is symptomatic and supportive. Mild local reactions can be managed with application of ice and oral antihistamines. More generalized reactions or local reactions of the head and neck may benefit from a short steroid course. Severe reactions are managed as outlined under "Treatment" above. Patients with severe reactions should be advised to carry self-administered epinephrine and antihistamines. A referral to an allergy specialist is indicated. I3,,7.,!3

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