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by Prashant Ponda, M.D., F.A.A.A.A.I., F.A.C.A.A.I.
There are several insects whose stings can result in allergic reactions. These include honey bee, wasp, yellow jacket, and hornet. There is also a prevalence of fire ant in the southern portion of the United States.
Allergic reactions can present in different ways ranging from a small local reaction that resolves without treatment to a life threatening reaction that affects multiple parts and organs of the body and requires immediate medical attention. A person’s symptoms can include redness, swelling, and itching of the skin, difficulty breathing, and feeling faint. Fortunately, life threatening reactions are rare and occur in approximately 0.5% of children and 3% of adults.
After you or a family member has experienced an allergic reaction to an insect sting, there are likely many questions that start going through your mind. Was this a mild or a severe reaction? Will it get worse with the next sting? What can I do to prevent a sting? What treatments should I have available? When can I treat the sting at home and when do I need to seek medical attention? Do I need to get tested to know to which stinging insects I am allergic?
For patients with severe reactions to insect stings, there are several measures that can be helpful: education regarding avoidance of stinging insects, having rescue medications prescribed and available (examples are an antihistamine and epinephrine), carrying medical information bracelets identifying the allergy, testing to see which stinging insects can cause reactions for that patient, and immunotherapy (venom shots) which can cure the allergy in the majority of cases.
Testing for stinging insect allergy involves placing a small amount of venom on the surface or just underneath the skin and observing for a small hive in the area. The results are available within 15 minutes. If the result is negative, then a higher concentration is used in the next round of testing.
Immunotherapy (venom shots) can be given to decrease or eliminate a patient’s allergy to a stinging insect. There is no medication in the injections, but rather the exact venoms to which a patient is sensitized as detected through testing. It works similar to any other vaccines that patients receive, such as the flu shot or tetanus shot. Since patients are allergic to the contents of the injections, the dose is built-up weekly over a period of several months until a maintenance dose is achieved. This maintenance dose is then administered once per month over a period of years. Ultimately, the goal is to shift a person’s immune system away from allergy and toward tolerance so exposure to the venom does not result in a clinical reaction.