Insect allergy affects nearly 10 million Americans. While most reactions are mild, severe allergic reactions to insects cause at least 40 deaths per year. Wasps, yellow jackets, hornets, bees and fire ants are the major culprits.
WHAT IS NORMAL, AND HOW IS IT TREATED?
Most reactions cause pain, swelling and redness at the sting site. Wash the area with soap and water, and apply ice to reduce swelling. Some people have a “large local reaction” causing swelling well beyond the sting site. Although alarming in appearance, treatment is the same as above. Since swelling can persist for days, antihistamines should reduce your discomfort. Yellow jackets, hornets and wasps sting repeatedly. Honeybees have barbed stingers which are left in your skin. Squeezing the stinger can release more venom into your body. Simply flick or scrape with a fingernail or credit card to remove.
Fire ants normally cause an itchy local hive at the bite site which usually resolves within an hour. About four hours later a small blister develops. Over the next 24 hours this clear fluid becomes pus-like. The usual treatment for fire ant bites is the same as above. Do not break the blister! Topical steroids and oral antihistamines can relieve the itching.
WHAT ARE SYMPTOMS OF A SEVERE ALLERGY?
Seek immediate medical attention if any of the following develop:
- hives, itching and swelling in areas other than the sting site
- chest tightness or difficulty breathing
- swelling of the tongue
- hoarse voice
The most severe allergic reaction called “anaphylaxis” can occur within minutes. Symptoms can include dizziness, cardiac arrest, throat fullness, or unconsciousness.
HOW DO YOU DIAGNOSE THESE ALLERGIES?
We should evaluate anyone over 16 years of age who has experienced any generalized reactions including hives or swelling, or any child who as experienced life threatening reactions. Since 20% of adults have antibodies to venom without being allergic, we only test patients who have had reactions. After taking a history, we will skin test for venom (or fire ant). For accurate results, wait at least four weeks after the sting (or bite). If testing is positive, we recommend starting allergy shots.
HOW DO YOU TREAT THESE ALLERGIC REACTIONS?
Our immediate goal is emergency treatment. Life threatening allergic reactions can progress very rapidly and require immediate medical attention. Patients who had previous allergic reactions should carry injectable epinephrine to treat any allergic reaction. We will prescribe an epinephrine 2 pack and instruct you how to use it. We recommend injecting at the first onset of a generalized reaction, then proceeding to an emergency facility immediately. As about 1/4 of patients will not respond completely to the first injection, a second injection should be given 10 minutes later if symptoms persist, or several minutes later if there's no improvement.