Introduction

Itching and swelling from insect stings annoy millions of Americans each year.  For some people, stings from certain insects can cause allergic reactions.  While most stinging insects do not cause an allergic reaction, honeybees, yellow jackets, hornets, wasps, and fire ants commonly cause allergic reactions in the United States.  Serious allergic reactions can be life-threatening and require emergency medical treatment.  For people that are allergic to insect stings, allergy injection therapy can help reduce reactions in the future.

Anatomy

Your immune system usually fights germs to keep you healthy.  If you have allergies, your immune system overreacts to fight ordinary substances that normally are not harmful, such as pollen or certain foods.  The substances that trigger an allergic reaction are called allergens.

Allergens are different for everyone.  For some people, the venom of a stinging insect causes the immune system to overreact.  Antibodies are produced in response to the venom.  When a person is stung again by the same type of insect, the venom interacts with the antibodies.  The antibodies trigger the release of histamine and other chemicals in the blood called mediators.  The mediators cause the symptoms of an allergic reaction.  The majority of allergic reactions to insect stings are not life-threatening.  However, in rare cases, a severe allergic reaction can cause death.

Causes

Honeybees, yellow jackets, hornets, wasps, and fire ants are stinging insects that live in the United States.  The venom in the sting can cause an allergic reaction in some people.

Symptoms

It is important to note that even people that are not allergic to insect stings can experience itching and swelling at the site of the bite.  However, people with an allergic reaction to insect venom experience symptoms at the site of the bite, as well as symptoms that affect the whole body.  Symptoms of an allergic reaction may develop immediately or take up to 24 hours to develop.  Itching, hives, tingling or itching inside of the mouth, nausea, vomiting, and skin flushing can be symptoms of an allergic reaction.  The symptoms and degree of allergic reaction to insect stings vary widely from person to person. 

For some, insect stings cause a severe life-threatening allergic reaction (anaphylaxis), and emergency medical help should be received.  In addition to the symptoms stated above, a serious reaction causes difficulty breathing or swallowing stomach cramps, and swelling of the tongue and throat.  A person’s voice may sound hoarse, or he/she may faint or feel dizzy. 

Life-threatening anaphylactic shock can rapidly develop.  Anaphylactic shock causes a sudden drop in blood pressure, and a person may lose consciousness.  Death can occur if a person stops breathing or if the heart stops beating.  Again, call 911 if you or a person near you develops a serious reaction to an insect sting.

Diagnosis

A doctor can diagnose an insect sting by examining the site.  Your vitals will be monitored if you are experiencing a severe allergic reaction.

Treatment

For minor stinging insect allergy symptoms, over-the-counter medications can help.  You should carefully remove the stinger if it remains in the skin.  Use care not to squeeze the stinger because doing so may release more venom.

People with a history of significant stinging insect allergies should follow their doctor’s instructions for using a prescription self-injectable epinephrine medication (Epi-Pen, ANA-Kit).  Emergency medical treatment should be received even with the use of self-injectable medication.  Call 911 if you or a person near you develops a severe reaction to an insect sting.

If you are allergic to insect venom, you should be evaluated by an allergist.  After performing a skin test, your allergist will let you know if you are a candidate for allergy immunotherapy shots.  The series of shots help reduce the body’s allergic response to insect venom.  After receiving venom immunotherapy shots for three to five years, the risk of a severe allergic reaction to stinging insects is minimized.

Prevention

You can minimize your allergic reaction to stinging insects by receiving allergy immunotherapy shots for insect venom.  If your doctor has prescribed a self-injectable epinephrine medication, you should carry it with you at all times, and teach the people that are commonly near you how to use it.  Call 911 if you experience a severe allergic reaction. 

You should avoid areas where stinging insects are located.  Contact a professional exterminator to remove insect hives or fire ant hills.  If you do disturb an insect colony, run in a zigzag pattern to shelter.

Am I at Risk

You are at risk for an allergic reaction to insect stings if:
• You had an allergic reaction to insect stings before.  In fact, it is most likely that your next insect sting by the same type of bug will produce a more severe allergic reaction than the last one.
• You are a male under the age of 20.  Males in this age range most frequently experience severe allergic reactions to stinging insects.

Complications

Although rare, it is possible for a severe allergic reaction to cause death.  If you or someone near you is experiencing a significant reaction to an insect sting, call 911.

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