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Each year millions of Americans are stung by bees, wasps, hornets, yellow jackets, and fire ants. These insects, members of the Hymenoptera family, inject venom into their victims when they sting. The usual, non-allergic reaction to a sting lasts only a few hours, resulting in redness, swelling, localized pain and itching at the site of the sting. These symptoms should resolve rapidly. Occasionally reactions can become more symptomatic, a condition called a large local reaction. This type of reaction may persist for several days, but it is not an allergic reaction.
A small percentage of people have allergies to these venoms, and such stings may be life-threatening. Approximately two million Americans are severely allergic to the venom of stinging insects. Severe allergy occurs when the victim’s immune system produces too much of a special type of antibody, called IgE, against the injected venom. Why only some people produce excessive amounts of IgE antibody remains unknown.
Allergic reactions to insect stings can involve many organ systems of the body and develop rapidly after the insect strikes. Symptoms may include nausea, dizziness, stomach cramps, and diarrhea, as well as more common allergy symptoms: itching and hives over large areas of the body, wheezing, and difficulty in breathing. In severe cases, a sharp fall in blood pressure may result in shock and loss of consciousness. The medical term for such a serious reaction is anaphylaxis. Anaphylactic reactions may be fatal without prompt emergency medical treatment.
Any person who has had a serious adverse reaction to an insect sting should be evaluated by an allergist. The allergist may recommend testing and, if appropriate, treatment and avoidance measures.
Skin tests are the standard method to identify stinging insect allergies, including those of wasp and bee allergies. In order to perform a skin test, venom extracted from a particular type of insect is diluted and placed on a patient’s skin for about 20 minutes. The doctor will then interpret the results. Based on the history and test results our doctors can then provide treatment and guidance to help make sure that this is managed properly. A course of immunotherapy injections may be prescribed. These have an extremely high success rate and are almost always curative.
Insect allergy blood tests are occasionally performed to either safely test people with severe reactions to insect venom or in situations where a standard skin test may not have provided conclusive results. Skin tests are the “gold standard” for evaluating people who are allergic to insect stings but on occasion for reasons that are not understood the test is only positive in the blood. People who are allergic to insect stings carry an allergy antibody called IgE that recognizes a specific insect and triggers a reaction subsequently when stung.
Hymen-optera-sensitive patients should take measures to avoid being stung. Calm, quiet behavior without sudden movement or waving of the arms when in the presence of these insects often prevents trouble. Other precautions include:
Prevention at home: The smell of food attracts most of these insects. Be careful when cooking, eating, or even feeding pets outdoors. Keep food covered until eaten. Insects are attracted to trash containers and fruit trees with fallen fruit, so keep trash areas clean and trash covered. Use insecticide sprays to keep insects away.
Watch for nests in trees, vines, shrubs, wood piles, under the eaves of the home, and in other protected places. Use hedge clippers, power mowers, and tractors with caution. Hymenoptera insects will sting if their home is disturbed, it’s important to destroy hives and nests around your home. The insect-allergic person should not perform or watch this potentially dangerous activity. A trained exterminator or another person skilled in hive removal should be employed.
Personal methods of prevention: Sweet odors attract insects. Persons allergic to stinging insects should avoid perfume, scented hair spray, scented suntan lotion, and other cosmetics. Because bees gather nectar from clover and other ground plants, don’t go barefoot; wear closed-toe shoes outdoors. Avoid loose-fitting garments that can trap insects between material and skin. Bright colors, flowery prints, and black clothing also attract stinging insects more than do light and muted colors like white, tan, khaki, and green. Hymenoptera sensitive persons should keep an insecticide aerosol in the glove compartment of their car in case a stinging insect becomes trapped inside.
When a sting occurs, the insect-allergic patient may require assistance in receiving prompt emergency treatment. Removal of the stinger from the skin immediately after the sting may prevent some harmful effects of the venom. Among Hymenoptera species, only the honeybee leaves her stinger (with venom sac attached) in the skin of its victim. Because it takes several minutes for the venom sac to inject all of the venom, instantaneous removal of the stinger and sac will limit the amount of venom received. A quick scrape of the fingernail removes the stinger and sac. Avoid squeezing the sac, as this forces more venom through the stinger and into the skin. Hornets, wasps, yellow jackets, and fire ants don’t leave their stingers. They should be brushed from the victim’s skin promptly with deliberate movements to prevent additional stings. The victim should quietly and immediately leave the area.
For long-term prevention and treatment, persons who are severely allergic to the venom of stinging insects can be treated with venom immunotherapy. Allergists use immunotherapy to administer gradually stronger doses of venom that stimulate the patient’s immune system to become increasingly resistant to future insect stings. Once the patient receives the highest dose of venom, they will have protection against future severe reactions.
Carolina Asthma and Allergy Center has been proudly serving residents in and around the Charlotte area since 1952. With a talented and professional staff made up exclusively of physicians who are board certified by the American Board of Allergy & Immunology, Carolina Asthma and Allergy Center offer expertise in insect allergy testing, preventative medicine and more. Both skin tests and blood tests can be performed by our licensed medical professionals to detect allergies to stinging insects – such as yellow jacket, hornets, wasps, bees and fire ants – that will allow us to create an effective treatment plan.
If a person has a wasp allergy, bee allergy, or another stinging insect allergy, they will exhibit clear signs that develop soon after a sting has taken place. These include but are not limited to the following:
• Hives or swelling that appears on the skin on a part of the body separate from the sting site. If this occurs, it usually begins within a few minutes of the sting, but on rare occasions it may take up to an hour to start.
• Swelling at the site of the sting is abnormal if it crosses two large joints Other non-visual adverse reactions may take place soon after a sting that can be dangerous or even deadly in severe situations, including:
• Difficulty breathing
• Wheezing or constriction in the throat
• Rapid and weak pulse
• Drop in blood pressure
• Uterine cramping
Typically, insect bites just result in mild symptoms, such as itchiness around the bite. But if an insect bite leads to throat swelling, dizziness or nausea, seek emergency treatment for an allergy.
Typically, people are allergic to one or the other. It is possible, however, to be allergic to both. An allergy test can tell you for sure.
Allergic reactions typically begin within a few minutes of the sting. Act quickly if you have an allergy to stinging insects and have been stung. Call 911 and administer an EpiPen if you have one. Rarely, an allergic reaction will take up to an hour.
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