Insect Sting Allergy: Symptoms, Diagnosis, and Treatment

This information was reviewed and approved by Kanao Otsu, MD, MPH (3/31/2019).

What is an insect sting allergy?

Most people think of bees or wasps when talking about stinging insects. Ants, hornets and yellow jackets are insects that also sting. These insects actually inject venom into your body, and an insect sting allergy is an allergy to that venom.

The most common reaction to an insect sting is a localized reaction. This is when the area around the sting becomes red and swollen.

An allergy to insect venom can be life-threatening. A systemic allergic reaction (also called anaphylaxis) can occur in some people. Insects that sting are members of the order of Hymenoptera of the class Insecta. Stinging insects of concern are found in three families:

Wasps and Hornets (Vespidae): Yellow jackets (which are wasps), yellow hornets, white-faced hornets and paper wasps all sting.
Bees (Apidae): Honeybees are the most frequent stinging insect. Bumblebees cause significantly fewer reactions, but both types of bees sting.
Ants (Formicidae): Fire ants, harvester ants, bulldog ants and jack jumper ants are all stinging insects. Harvester ant stings are painful, but are a less common cause of a severe reactions, called anaphylaxis. Stings from red imported fire ants (RIFA) are known to cause severe allergic reactions in their habitat in the southeastern U.S. and along the Gulf Coast. They characteristically bite to attach themselves to their victim and then sting multiple times in a semicircular pattern, with a sterile pustule forming at each sting site after several hours.

There have been isolated case reports of systemic allergic reactions to bites from deer flies, kissing bugs, bedbugs and mosquitoes, but such reactions are rare. More common are large local reactions to these bites that, although unpleasant, are not life-threatening.

Transcript

Stinging insect allergy generally involves an allergy to the sting of what we term the Hymenoptera which are the stinging insects generally includes hornets, wasps, bees, even fire ants can cause a similar type of allergy.

Symptoms of Insect Sting Allergies

And certain individuals will be allergic to the venom from the stinging insect whereas other individuals will not.

In a nonallergic individual, you can still get redness, pain, local swelling.

That’s pretty common with any stinging insect, if it starts spreading in a limb beyond the elbow, for instance, beyond the wrist all the way down the hand or you start getting symptoms elsewhere like hives on the leg when you are stung in the arm, swelling which can be especially relevant in the face, tongue, throat that can cause trouble breathing or even a full blown allergic reaction where multiple systems get involved and some individuals will even feel their blood pressure drop, feel like they’re going to faint.

Stinging insects can be very serious in terms of allergy and can cause even fatal reactions.

How to Diagnose Insect Sting Allergies

We will start with a clinical history which can give us some clues.

And often times patients will know exactly what they were stung by or that they were stung right next to a wasps’ nest so that we can guess that it was the wasp.

But, we’ll generally do a full panel of testing, both with skin prick testing, where we put an extract to every stinging insect that we know.

And then we will gradually increase the concentration of the prick and move into an intradermal tests where it is injected under the skin and then we’ll separately also do specific IGE testing which is looking for the specific IGE which is the allergic antibody against each of these stinging insects.

Treatment Options for Insect Sting Allergies

The most important thing for patients who are truly allergic to insect stings is to carry an epinephrine auto injector and to know how to use it.

So, making sure that they themselves know how to use it other loved ones who will be around them at a time when they might get stung also knows how to use them.

In addition, we advise avoidance of some areas where we know that stinging insects tend to hide.

So, for instance, a soda can at a picnic.

There might be a stinging insect in there and drinking that stinging insect could cause you problems in terms of an allergic reaction.

In addition, there actually are allergy shots against stinging insects so that is something that a lot of people are not aware of, but certainly in patients who have had severe insect sting reactions, some of which have been life threatening, or people who work in areas such as golf courses or as bee keepers where they really can’t practice avoidance, then we’ll try to make them tolerant of the stinging insect venom by doing allergy shots.

Visit njhealth.org/allergy for tips on how to avoid stinging insects.

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