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Topic of the Month - June - Stinging insect allergy: How to avoid the ouch
In this Topic of the Month, you will learn about::
- What is an allergic reaction to stinging insects?
- What are common stinging insects?
- How can insect stings be prevented?
- How can insect stings be treated?
- What are the warning signs of anaphylaxis?
- When should someone see an allergist/immunologist?
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Summer brings outdoor activities such as swimming, baseball and barbecues. However, the warmer weather also brings something else: stinging insects. For those people who have severe allergic reactions to stinging insects, we can help ensure a safe summer by answering questions about the prevention and treatment of insect stings.
What is an allergic reaction to stinging insects?
Up to 5% of Americans are at risk for a severe, potentially life-threatening allergic reaction from insect stings. This reaction is called anaphylaxis. Unfortunately, most people are not aware that they are allergic to insect stings until after experiencing a reaction.
An allergic reaction occurs when the immune system overreacts to the insect venom. When this happens, an allergic person's body produces an allergic substance called Immunoglobulin E (IgE) antibody, which reacts with the insect venom. This triggers the release of histamine and other chemicals that cause allergic symptoms.
In the most severe of cases, there can be a rapid fall in blood pressure which can result in the loss of consciousness, and can sometimes lead to death. Therefore, insect stings must be taken seriously.
What are common stinging insects?
Because allergic reactions to insect stings can often be severe, it is important to know what common stinging insects look like and where they often live. Most sting reactions are caused by five types of insects:
 Yellow jackets: These are black with yellow markings, found in various climates. Their nests are usually located underground, but sometimes found in the walls of buildings, cracks in masonry or in woodpiles.- Honeybees: These have a round, fuzzy body with dark brown and yellow markings. This bee will leave its stinger in its victim and the bee dies as a result. These are usually non-aggressive, stinging only when provoked, except for their more aggressive cousin in the southwest. They can be found in honeycombs in trees, old tires, or other partially protected sites.
- Paper wasps: These are slender with black, brown, red and yellow markings. They live in a circular comb under eaves, behind shutters or in shrubs and woodpiles.
- Hornets: These are black or brown with white, orange or yellow markings. Their nests are gray or brown and usually found in trees.
- Fire ants: These are reddish-brown ants living in large mounds, mostly in warmer climates. They attack with little warning, inserting highly concentrated toxins that cause burning and pain.
How can insect stings be prevented?
It is important for anyone with severe allergies to insect stings to take precautions to avoid a potentially dangerous reaction. Follow these steps to help protect yourself from being stung:
- Avoid the "territory" of the stinging insect's nest. These insects are most likely to sting if their homes are disturbed, so it is important to have hives and nests around your home destroyed. Since this activity can be dangerous, hire a trained exterminator.
- Remain calm and quiet, and slowly move away from stinging insects.
- Avoid brightly colored clothing and perfume when outdoors. Many stinging insects are searching for food and could confuse you with a flower.
- Be careful when cooking, eating or drinking sweet beverages like soda or juice outdoors. Be sure to always keep your food and beverages covered until consuming them.
- Wear closed-toe shoes outdoors and avoid going barefoot to steer clear of stepping on a stinging insect.
- Avoid loose-fitting garments that can trap insects between material and skin.
How can insect stings be treated?
Allergic or not, insect stings cause discomfort. It is important to properly take care of the sting to ease the pain. Use the following tips to help:
- Elevate the affected area and apply ice or a cold compress to reduce the swelling.
- Gently clean blisters with soap and water to prevent secondary infections; do not break the blisters.
- Use topical steroid ointments or oral antihistamines to relieve itching.
- Monitor carefully for symptoms of anaphylaxis. If you experience symptoms, call 911 to get emergency medical treatment immediately.
- Do not pinch the area to remove the stinger. This can result in more venom being released into the skin.
- If severely allergic to insect stings, inject epinephrine immediately and call 911.
How can insect stings be treated?
Allergic or not, insect stings cause discomfort. It is important to properly take care of the sting to ease the pain. Use the following tips to help:
- Elevate the affected area and apply ice or a cold compress to reduce the swelling.
- Gently clean blisters with soap and water to prevent secondary infections; do not break the blisters.
- Use topical steroid ointments or oral antihistamines to relieve itching.
- Monitor carefully for symptoms of anaphylaxis. If you experience symptoms, call 911 to get emergency medical treatment immediately.
- Do not pinch the area to remove the stinger. This can result in more venom being released into the skin.
- If severely allergic to insect stings, inject epinephrine immediately and call 911.
What are the warning signs of anaphylaxis?
Severe allergic reactions to insect stings can involve many body organs and may develop rapidly. This reaction is called anaphylaxis. Anaphylaxis is a severe allergic reaction that can result in trouble breathing, loss of consciousness and even death. Anaphylaxis is a medical emergency that requires immediate medical treatment, and later follow up care by an allergist/immunologist.
Anaphylaxis occurs in people after they are exposed to a substance to which they are severely allergic to, such as insect stings, foods and medications. Symptoms of anaphylaxis include:
- Itching and hives over large areas of the body
- Swelling in the throat or tongue
- Difficulty breathing
- Dizziness
- Stomach cramps
- Nausea
- Diarrhea
- In severe cases, a rapid fall in blood pressure may result in shock and loss of consciousness
When should someone see an allergist/immunologist?
If you have experienced a severe reaction to insect stings or you think you may be allergic, consult with an allergist/immunologist to accurately diagnose your condition. An allergist/immunologist is the best qualified medical professional trained to manage the prevention, diagnosis and treatment of allergies and asthma.
An allergist/immunologist might also suggest allergy shots, also known as immunotherapy treatment. Venom immunotherapy shots take effect within just a few months. Venom immunotherapy is the closest thing to a "cure" for allergic reactions. It is shown to be 97% effective in preventing future allergic reactions.
The AAAAI's How the Allergist/Immunologist Can Help: Consultation and Referral Guidelines Citing the Evidence provide information to assist patients and health care professionals in determining when a patient may need consultation or ongoing specialty care by the allergist/immunologist. Patients should see an allergist/immunologist if they:
- Have reactions possibly due to insect stings for accurate identification of specific allergen and consideration for immunotherapy (allergy shots).
- Have systemic reactions possibly due to biting insects, for accurate identification of specific allergen.
- Have a severe allergic reaction (anaphylaxis) without an obvious or previously defined trigger.
- Have had anaphylaxis attributed to food, drugs, or insect stings.
To find an allergist/immunologist in your area, call the AAAAI Physician Referral and Information line at (800) 822-2762 or visit http://www.aaaai.org/physref/.
Additional Resources
This topic was reviewed on 6/1/2007 by Stuart Friedman, MD, FAAAAI, Patients & Consumers Web Editor.
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