Insect Sting Allergy: Diagnosis

Reviewed by David Tinkelman, MD

The first step in making the diagnosis of insect venom sensitivity consists of taking a careful history and attempting to identify the responsible insect. 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 a fatal event for a honeybee. However, this alone is not diagnostic of a honeybee sting because vespids can also lose their stingers about 8 percent of the time.

Unfortunately, accurate identification of the insect based on the history alone is not always possible. People with histories suggestive of significant sting sensitivity should be referred to an allergist. The usual procedure is to skin test with the five commercially available venoms: honey bee, 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 venoms (RAST).

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