Warm weather is here and with it comes the increased risk of stings from both flying and crawling, stinging insects. Venoms from insects such as: honeybees, hornets, wasps, yellow jackets, and fire ants are generally a nuisance, and can be treated with home remedies. There are however, about 2 million Americans who have allergies to the venoms of stinging insects. These reactions range from mild to severe, and sometimes fatal. Symptoms of stinging insect allergy can vary depending upon how allergic the person is, where on the body the person is stung, when the person is stung, the number of stings sustained at one time, and the type of insect that has done the stinging. Having one type of reaction does not mean that you will have the same reaction each time you are stung, or that the next reaction will be more severe.

Knowing the symptoms associated with each degree of severity of reaction can help guide appropriate treatment for the sting. Usually, sting symptoms are mild and require no medical attention. A person may develop sharp, burning pain at the sting site, and / or raised red skin and swelling around the sting area. For most individuals, these symptoms resolve within several hours. With more moderate sting reactions, the body has a more significant response to the insect’s venom. Such reactions include: severe redness around the sting, with swelling which may gradually increase in size to a diameter of 10 or more centimeters over a 24-48 hour period. This is known as a large local reaction (LLR) which usually resolves over 5-10 days. For both mild and moderate reactions it is always advisable to remove the stinger with a pair of tweezers, while carefully avoiding squeezing the venom sac; this will decrease the amount of venom released into the bloodstream. Localized reactions can be treated with cold compresses, steroid creams, and oral antihistamines in order to reduce inflammation and itching. 

Approximately 5%-7.5% of people will experience a severe allergic reaction (anaphylaxis) to insect stings in their lifetime. These reactions can be potentially life-threatening and require emergency treatment. Signs and symptoms of anaphylaxis include: difficulty breathing, swelling of the throat/tongue, generalized hives, flushing, or pallor, nausea, vomiting, and/or diarrhea, weak, rapid pulse, and syncope. Persons who experience anaphylaxis to stings have a 25%-65% risk of anaphylaxis if they are stung in the future. If you experience anaphylaxis following a sting, it is advisable to seek care from a local allergist who can perform testing in order to specifically diagnose your venom allergy, and institute venom immunotherapy if warranted. At the very least ALL persons who have experiences anaphylaxis to insect stings should carry with the both diphenhydramine  (Benedryl) and  an Epi-pen device at all times. 

These are practical measures which can help reduce the risk of stings by stinging insects. Avoid wearing brightly colored or floral print clothing as well as perfumes and after-shave. Wear shoes or sandals when outdoors – yellow jackets and fireants have underground nests. Keep outdoor foods and drinks covered; inspect these before ingestion. Keep windows closed while driving. If you do come into contact with a stinging insect do not swat at it as it may sting in defense; remain calm and slowly move away. If you locate a nest in your house or garden, have it professionally removed. 

Angelina J. Lombardi, M.D.Allergic Disease and Asthma Center, P.A.