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Stinging insect allergies can be serious
Patrice
Kirchoff, MD
Allergy Partners of the Blue Ridge
The warm weather for most signifies the start of baseball, barbecues, and long days at the pool. For people allergic to stinging insects, warm weather means avoiding the outside as bees, hornets and wasps become more prevalent. In their case, it may be a matter of life or death.
Allergic reactions to insect stings have been
recognized since ancient times. The death of King Menes from a hornet
sting is depicted in Egyptian hieroglyphics. It has been estimated
that allergic reactions to stings accounts for 40
deaths every year in the United States. Serious, non-fatal reactions
occur in one to 10 persons per 100,000 every year.
The most common cause of stinging insect allergy results from the stings of the honeybee, wasp, hornet, or yellow jacket. Identification of the specific insect is often difficult. Honeybees are the only insect that loses its stinging mechanism, which results in its immediate death.
Wasps build honeycomb nests under eaves and rafters. Hornets reside in large oval paper-mache type nests that hang from trees and shrubs. Yellow jackets are responsible for the most reactions and reside in hives in the ground or under logs.
Normal reaction from a sting consists of pain, redness and swelling. This usually lasts for hours and disappears. Some experience swelling which spreads from the site of injection and may last for days. This is still considered a large local reaction and generally responds to ice and antihistamines.
It does not affect breathing or blood pressure. The most serious reaction is anaphylaxis and may be life threatening. Symptoms include hives, generalized itching, flushing, swelling outside of the sting, which may affect the airway, wheezing, shortness of breath and dizziness or loss of consciousness. A sense of doom often accompanies the above symptoms.
The majority of reactions resulting in death occur in adults. Two factors which play a big role in such reactions involve the airway, which leads to airway compromise and a drop in blood pressure, which results in shock. Unfortunately most individuals have no previous warning of stinging insect allergy.
The diagnosis of stinging insect allergy is generally evident from a patient’s medical history. It can be confirmed with skin tests, which consist of graded injections of the purified venom. A raised welt signifies an allergy to that insect.
Treatment for sting reactions depends on the type of reaction. The normal local reaction generally resolves on its own. Cool compresses and antihistamines may ease the pain and itch. Large locals are treated similarly. If the swelling is extreme and persists for days, steroids may speed the healing process.
Systemic reactions may require epinephrine to ease swelling of the airway and increase blood pressure. Antihistamines are given after epinephrine, and steroids will block a delayed reaction which may occur six to eight hours after the initial sting.
Most systemic reactions should be treated in an emergency room. In some cases oxygen, IV fluids, and multiple injections of epinephrine in preloaded syringes should be carried at all times. These can be used if further stings occur in order to allow time for transfer to an emergency room.
Patients who have had an anaphylactic reaction have
a 40 to 60 percent chance of having a similar reaction with future stings. These
patients are candidates for allergy injections to desensitize them to the
venom. If history and skin tests confirm venom allergy, allergy injections
of protection in greater then 95 percent of cases, allow these patients
the freedom to once again enjoy the outdoors.
Allergy Partners, P.A. provides diagnostic testing and treatment of allergies, asthma and sinus diseases in a caring and professional environment, nation-wide at 22 office locations.
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