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Insect Sting Allergy (Ant, Wasp and Bee Stings): Diagnosis

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

Making a correct diagnosis of allergy to bee, wasp or insect sting (insect venom) is important, because people with this allergy are candidates for venom immunotherapy (allergy shots). 

Allergy shots can dramatically reduce the risk of recurrent severe reactions.

The first step in making the diagnosis of wasp sting or other insect venom allergy is a careful history of the types of insects and the reactions you have to their stings.

Insect sting allergy symptoms are broadly divided into localized reactions and systemic reactions. 


Identify the Insect you are Allergic to

If you didn’t see the insect that stung you, take a look around where you were stung. Do you see honeybees flying around? Is there a yellow jacket nest nearby? Are you standing on an anthill?

Nesting and behavior patterns and a description of the insect and the sting may aid identification. For example, honeybees, because their stinger is barbed, usually lose their stinging apparatus, leaving it stuck in the victim at the site of the sting. Thus, stinging is often a fatal event for a honeybee. However, this alone is not diagnostic of a honeybee sting, because vespids (types of wasps) can also sometimes lose their stingers.

Unfortunately, accurate identification of the insect based on the history alone is not always possible. People with histories suggestive of significant sting allergy should be referred to an allergist. The usual procedure is to complete allergy skin tests with the five commercially available insect venoms. These include honeybee, paper wasp, yellow jacket, yellow hornet and white-faced hornet. When appropriate, whole-body extracts for imported fire ant, harvester ant and several biting insects are also available for testing. If the history is very suggestive of a generalized reaction and skin tests are negative, they should be repeated as well as obtaining blood tests for specific insect venoms (RAST).

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