It is estimated that one to two million people in the US are severely allergic to the venom of stinging insects with approximately 50 – 150 deaths per year. The majority of most insect stings in the US come from wasps, yellow jackets, hornets and bees. In the southern US states, fire ants may be the number one cause of insect stings.
The most severe form of an allergic reaction, called “anaphylaxis,” can result in any combination of these symptoms:
The reaction usually starts minutes after the sting and can be life threatening and occasionally fatal. Patients who have had an allergic reaction to an insect sting have a 60% chance of a similar, possibly more severe reaction when they are stung again.
Insect sting allergy is treated in a two-step approach.
The first step is the emergency treatment of the symptoms of a serious reaction. Life threatening allergic reactions can progress very rapidly and require immediate medical attention. Emergency treatment usually includes the administration of certain drugs, such as epinephrine, antihistamines, and in some cases, corticosteroids, intravenous fluids, oxygen and other treatments.
The second step is preventative treatment of underlying allergy with venom immunotherapy. Based on your past history the allergist will determine if you are a candidate for skin testing and immunotherapy. Injectable epinephrine to carry for self-administration is often prescribed as emergency rescue medication for treating an allergic reaction.
By skin testing with specific venoms, your physician is able to accurately diagnose allergies to specific insects in most instances. A past experience you may have had with insects are also important for your physician to know. They can give you vital clues that would be helpful if you could describe the insect that stung you, the symptoms you may have had and any treatment you were given.
The long term treatment of insect sting allergy is called venom immunotherapy, a highly effective program administered by an allergist, which can prevent future allergic reactions to insect stings. This treatment has been shown to be 97% effective. Venom immunotherapy involves administering gradually increasing doses of venom to decreases the patients sensitivity to the venom. This can reduce the risk of a future allergic reaction to that of the general population. In a matter of weeks to months, people who previously lived under the constant threat of severe reactions to insect stings can return to leading normal lives.
If you are allergic to any of the stinging insects, your doctor may also advise you to carry a form of injectable epinephrine for self-administration. This is especially important during the time before the patient reaches the maintenance dose level and before the immunotherapy provides protection. The epinephrine is available as an auto-injector. You would be instructed on how to inject this material into an appropriate site, such as your thigh, in emergencies.
Epinephrine is often effective in slowing or stopping the reaction, but is not always enough. In some cases, intravenous fluids, oxygen and other treatments are necessary, so you should still seek medical attention after being stung. The epinephrine might also be ineffective in combination with certain other medications and over time many patients tend to forget to carry it with them. For these reasons epinephrine should not be seen as a substitute for immunotherapy.
Your doctor can explain preventative steps to try to protect yourself from locations, situations and clothing that attracts these insects.
Allergic reactions to insect stings can be very serious and there is a high probability for patients to have a similar or more severe reaction when they are stung again. Venom immunotherapy has shown to be extremely effective in eliminating a reoccurrence of an allergic reaction. Patients should also practice avoidance measures and carry epinephrine for self-administration in emergencies. By taking these steps, much of the fear and anxiety of being suddenly victimized by the sting of an insect can be relieved, leading to a freer, happier life.
Please consult an allergy specialist if you have any questions about venom immunotherapy or the prevention to stinging insects.