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That Stings!

Venom and Allergic Reactions

During spring and summer, bees and other flying insects are busy collecting food. Unfortunately, sometimes we humans get in their way. In order to protect themselves, they end up attacking and stinging us. Most insect stings produce only local discomfort. Occasionally it can lead to more severe reactions called anaphylaxis.

Anaphylaxis from insect stings results in a significant number of fatalities each year. It is estimated that potentially life-threatening systemic (or full-body) reactions to insect stings occur in .4 to .8 percent of children and 3 percent of adults. At least forty deaths from reactions to insect stings occur in the United States annually. It is likely that additional deaths are due to insect stings that haven’t been recognized and therefore not reported. Some insect stings contain venom that can lead to an allergic reaction.Examples of these are yellow jackets, hornets, wasps, honeybees, and fire ants.These insects are very different but they can all make venom that causes inflammation when inserted through the sting.

Most people experience only local reactions. Localized reactions are not dangerous and no specific treatment is required. Reactions consist of redness, swelling, itching, and pain at the sting area.Sometimes the sting area can become large with extensive red swelling surrounding the site. There may be involvement of more than one joint area and symptoms may persist for several days. In some cases it may take five to ten days to resolve. It may be accompanied by itching, pain, or both. Treatment, which is aimed at reducing local pain, itching, and swelling, consists of cold compresses, oral antihistamines, and/or oral analgesics.

The risk of a systemic reaction in patients who experience large local reactions is no more than five to ten percent. Systemic reactions range from skin responses (like hives and swelling) to life-threatening reactions which manifest as wheezing, difficulty breathing, difficulty swallowing, anxiety, and decrease in blood pressure. Treatment of anaphylactic reactions caused by insect stings is the same as for other causes of anaphylaxis. The mainstay of treatment is prompt administration of emergency epinephrine. If a stinger is present, it should be removed as quickly as possible.

Of course, avoiding being stung is the first line of management. When eating outside, keep food and drinks covered and wipe up any spills. Check for yellow jackets inside drink containers. Do not walk outside without shoes. If you find a wasp nest near your home, do not try to get rid of the nest yourself. Instead, call a pest control professional. If you have a sting allergy, avoid activities that may disturb a nest, such as mowing the lawn or pruning a hedge. If a stinging insect is near, slowly back away and do not flail your arms.If you are being swarmed or stung, cover your mouth and nose with your hand and run inside a building or an enclosed vehicle.

You might also want to explore allergy shots, also called venom immunotherapy, which can reduce your chance of having a life-threatening reaction to a sting.Allergy shots usually contain purified venom. The first few allergy shots contain very small amounts of venom, and the amount is gradually increased in order to desensitize you to potential future stings.Allergy shots are often recommended if you have had a serious allergic reaction after being stung and you have evidence of allergy on testing.

Ananth Thyagarajan, MD, or Dr. T as he is known by many of his patients, is an allergist-immunologist and father of two. He specializes in allergy, asthma, and food allergy and sees patients at Allergy Partners of Richmond.
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