General Information

  • Stinging insects include yellow jackets, hornets, wasps and bees
  • While many people develop large itchy bumps on the skin following a mosquito bite, an allergy to mosquito bites that can cause severe symptoms is extremely uncommon
  • People often have a simple local reaction, localized skin swelling and pain at the sting site, after being stung
  • Two main types of reactions are large local reactions and systemic allergic reactions

Large Local Reactions

  • Swelling of the skin more than 10cm at the site of the sting
  • Large local reactions can occur in 5 - 10% of people
  • Only 5 - 10% of patients with large local reactions have more serious reactions in the future

Systemic Allergic Reactions

  • Systemic allergic reactions to insect stings occur in about 1% of children and 3% of adults
  • Symptoms often occur within minutes up to 2 hours after being stung:
  • Outside Symptoms
    • Face: Redness, itchy eyes / nose, swelling
    • Skin: Itching, redness, hives, swelling
  • Inside Symptoms
    • Face: Swelling lips and tongue, itchy mouth
    • Throat: Itching, tightness, hoarse voice, cough
    • Lungs: Trouble breathing, shortness of breath
    • Stomach: Vomiting, nausea, stomach pain, diarrhea
    • General: Dizzy, unsteady, drowsy, fainting
  • Not every reaction will look the same, a person can have different symptoms each time
  • Symptoms range from mild to life threatening, there is no way to predict if the reaction will be mild or severe
  • Anaphylaxis is a severe life threatening reaction with more than one body system affected (skin, breathing, stomach, general) and can occur WITHOUT skin symptoms such as hives
  • Antihistamines such as Benadryl will NOT stop severe reactions
  • An epinephrine auto injector such as Allerject or EpiPen MUST be available at all times
  • If you are visiting an area without access to a hospital you should have 2 auto injectors available
  • A medical identification device such a Medical Alert bracelet should be worn to outline the venom allergy and that an epinephrine auto injector is carried
  • Give epinephrine in the outer thigh if there are any of the following symptoms (listed in the table on the previous page)
    • General symptoms
    • Severe outside symptoms
    • Any inside symptoms
    • If you are in doubt, give the epinephrine
  • After epinephrine is given
    • Lie down / lie your child down
    • Call local emergency service and tell them someone is having an allergic reaction
    • If the reaction continues or worsens, give a second dose of epinephrine in 5 - 15 minutes (there is only 1 dose of epinephrine in each auto injector, a second dose requires a new auto-injector)
    • Go to the nearest emergency room even if the symptoms are gone because the reaction can worsen or come back
    • Stay in the hospital for at least 4 - 6 hours of observation

Avoiding Stinging Insects

  • Have known or suspected nests in the immediate vicinity of the home removed
  • Avoid wearing brightly coloured clothing or flowery prints
  • Avoid using any strongly scented material that might attract insects
  • Avoid walking outside barefoot or with open shoes (sandals)
  • Wear long pants, long-sleeved shirts, socks, shoes, head covering, and work gloves when working outdoors
  • Be cautious near bushes, eaves, and attics and avoid garbage containers and picnic areas
  • Keep insecticides approved for use on stinging insects readily available
  • Avoid eating or drinking outdoors and be cautious in situations outdoors in which food and beverages are being served (special care should be taken when drinking from opaque containers and straws)

Treatment of Venom Allergies

  • The age of the person and the type of reaction will determine if skin testing and treatment is needed
  • Large local reactions are treated with a cold cloth, pain medication (ex ibuprofen, acetaminophen) and antihistamines (ex cetirizine) if needed
  • Immunotherapy (IT) / allergy shots can be considered if the large local reactions are frequent and unavoidable
  • Patients with systemic reactions require treatment for venom allergy
  • The treatment for venom allergy is immunotherapy (IT) / allergy shots
  • IT is given as an injection with a small needle in the upper arm starting with a weak concentration of the allergen and gradually increasing
  • There are two phases for IT
    • Build up phase involves receiving injections with increasing amounts of the allergens about one to two times per week. The length of this phase varies from 1 - 6 months
    • Maintenance phase begins once the effective dose is reached
    • During the maintenance phase, there will be longer periods of time between treatments, usually 4 weeks in most cases
  • The IT will continue for 5 years
  • Please see the immunotherapy patient handout for more details on IT
  • During this time you / your child will have to carry an epinephrine auto injector