Insect Sting Allergy
Stings from bees, wasps, and hornets can be really painful. For some people, the reaction can be much more severe, resulting in a life-threatening allergic reaction.
Your allergist can help sort out if your reaction is life threatening and can provide treatments to significantly reduce your risk of a reaction in the future.
Large Local Reactions
Swelling that occurs at the site of the sting can range from small and mild to extension over the whole limb. They can continue to grow for 24-48 hours and last as long as 7-10 days. These reactions can be painful and uncomfortable, but are generally not life-threatening
Allergy shots are generally not prescribed for such reactions, as rates of anaphylaxis are not increased in people with these types of reactions.
Cutaneous systemic reactions are different from large local reactions in that the reactions develops away from the site of the sting. This reaction is not as severe as anaphylaxis but patients may be at a higher risk of an anaphylactic reaction from a future sting, depending on many factors, particularly age.
The decision to skin test or provide allergy shots is a decision that will be made between you and your allergist.
Cutaneous Systemic Reactions
This is a severe life-threatening allergic reaction. The symptoms include:
Flushed face, hives or a rash, red and itchy skin
Swelling of the eyes, face, lips, tongue and throat, trouble swallowing
A tight feeling in the chest, trouble breathing or speaking
Cramps, diarrhea, vomiting
Rapid heart beat
Anxiety, distress, feeling faint, sense of doom
Loss of consciousness
It is important to note that allergy skin testing is not predictive in patients with local reactions or who have never been stung.
The first step is making sure that allergic patients prevent stings. Some things that can help prevent a sting include:
Avoid areas where stinging insects gather: gardens, hedges, fruit trees, and garbage cans
Keep garbage cans covered with tightly fitted lids in outdoor areas
Have insect nests moved by an experienced professional
Wear light colours and avoid loose flowing clothes/hair, which can entrap an insect
Where shoes outdoors rather than sandals or bare feet
Avoid strong scents, such as perfumes or colognes, that can attract insects
Drink from cups rather than beverage cans or bottles where insects can hide - use a straw when possible
Treating Local Reactions
If you have a large local reaction (see above), you can relieve your symptoms with antihistamines or cold compresses. You may need higher than usual doses, so speak to your allergist or another physician about managing large reactions in the future.
If you have an anaphylactic reaction (see above), you must use your epinephrine injector.
Epinephrine is the only medication that optimally treats anaphylaxis. It is most effective if given before symptoms become severe, therefore should be given as soon as symptoms appear. The injection must be followed by further treatment and observation in the Emergency Department of your nearest hospital.
You should carry your epinephrine injector at all times and you should be familiar with how to administer it. Check the expiry date regularly or register for reminders on the product website. Antihistamines or puffers may be given by a physician in addition to epinephrine but are not substitutes for epinephrine.
Long Term Management
Illustrations used with permission. Provided courtesy of EBME inc.
Fortunately, anaphylactic reactions to stinging insect venom can be essentially cured. Allergy shots for stinging insect venom may be indicated and should be discussed with your allergy specialist.
Most patients who are candidates for allergy shots will undergo therapy for a total of 5 years. Some patients with very severe reactions may require treatment for life.
Your allergist will discuss the risks and benefits of this treatment to help you decide if it's right for you.