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Stinging Insect Allergy

By Asriani Chiu, MD|Anita Gheller-Rigoni, DO|Amit Kumar, MD
American Academy of Allergy, Asthma, & Immunology

When an insect sting turns severe

The thought of having a severe reaction from a stinging insect can strike fear in individuals, especially children. The goal of this review is to educate individuals on stinging insects, including identification, avoidance and treatment in the event of a reaction.

Reactions to insect stings

Different people will have different reactions to insect stings. Many children may experience only mild swelling in the area of the sting, while others may suffer a life-threatening reaction known as anaphylaxis. If your child has ever had a severe reaction to an insect sting, consult with his allergist/immunologist about preparing for and treating future stings.

Local reactions are mild and are the most common reaction to a stinging insect. Symptoms, which can include swelling, redness, and pain at the site of the sting, can last up to one week. These stings are best treated by applying an ice pack to the affected area, taking a pain reliever such as ibuprofen or acetaminophen, and/or using an antihistamine.

Children with an insect sting allergy will have a more severe reaction that can affect the entire body, or areas of the body away from the sting site. Symptoms of a severe reaction may include:
  • Hives
  • Swelling or itching of the skin
  • Difficulty breathing
  • Dizziness
  • Stomach cramps
  • Nausea
  • Diarrhea
  • Vomiting
  • Loss of consciousness
If your child experiences any of these reactions, seek medical attention immediately. Treat your child with his epinephrine auto-injector and call 911.
 
There are other, more rare types of reactions to be on the lookout for, as well. Toxic reactions can occur in both allergic and non-allergic individuals and are a result of multiple stings and a large amount of insect venom. Symptoms are similar to those experienced in a systemic (allergic) reaction, but individuals do not have to be previously stung.
 
Delayed reactions occur in less than 0.3% of insect stings and can occur days to weeks after the sting. Symptoms are varied but may manifest as hives, joint pain, fever and fatigue.

Identifying Stinging Insects

The majority of stings in United States come from wasps, yellow jackets, hornets and honeybees. In the Southern United States, the fire ant has also become a major cause of insect sting. All but the honeybee can sting repeatedly.

Wasps are long and thin. Their markings can be black, brown or red with yellow. Their paper-like nests form a circular comb of cells and are typically located in wooded areas, under eaves, in shrubs or in wood piles.

Yellow jackets are black with yellow. Their paper-like nests are typically located in the ground.

Hornets are black or brown with white, orange or yellow markings. They are larger than the yellow jacket with an “hour glass” shape. They create gray, brown, football-shaped paper nests usually found above the ground in shrubs or on the branches of trees.

Honeybees are brown with yellow and appear “furry.” They may leave their barbed stinger behind and this should be removed with a sweeping motion to prevent squeezing more venom into the victim. Though the honeybee is typically not aggressive unless provoked, the Africanized honeybee is more aggressive and may sting in swarms.

The fire ant is reddish brown or black. They nest in the soil, often near moist areas, such as river banks, pond edges, watered lawns and highway edges. Nests are dome-shaped mounds that can reach heights of up to 40 cm. The fire ant may sting multiple times in a circular pattern, leaving pus filled bumps (called pustules) at the location of the sting.

Avoiding Insect Stings

Share these tips with your child to prevent insect stings:
  • Avoid wearing sandals or walking barefoot in the grass.
  • Never swat at a flying insect. If need be, gently brush it aside or patiently wait for it to leave.
  • Check open beverages and drinks. Stinging insects can crawl inside a sweet beverage like soda.
  • When eating outdoors, try to keep food covered at all times.
  • Garbage cans stored outside should be covered with tight-fitting lids.
  • Avoid sweet-smelling perfumes, hair sprays, lotions, colognes and deodorants.
  • Avoid wearing bright-colored clothing.
  • Keep doors closed and screens on windows and doors repaired.
  • If your child has a known stinging insect allergy, keep prescribed medications readily available at all times. These medications are for immediate emergency use while en route to a hospital emergency room for observation and further treatment.

When to see an Allergist

Individuals who have experienced a severe or systemic reaction from a stinging insect may benefit from an evaluation by an allergist/immunologist. The allergist/immunologist will obtain a thorough history and examination and perform skin and/or blood testing to determine if your child has a stinging insect allergy.

If your child is found to be allergic, his allergist/immunologist may recommend venom immunotherapy. This treatment involves giving a series of tiny insect venom injections to build up immunity to stings. The treatment starts as weekly injections with gradually increasing doses. This is a highly effective, long-term treatment that can help prevent reactions to future stings.

 

 
Asriani M. Chiu, MD,FAAAAI, Anita I. Gheller-Rigoni, DO, and Amit Kumar, MD, are allergist/immunologists based in Milwaukee, Wisconsin.
 
The American Academy of Allergy, Asthma & Immunology is the largest professional medical association devoted to the research and treatment of allergic disease. The AAAAI offers educational materials for patients online at www.aaaai.org.

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