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Allergic reactions to insect stings

For most people being stung by an insect means swelling, redness and pain at the site of the sting, which lasts several hours to a few days, and may be treated sufficiently with ice, anti-inflammatory medications and pain relievers. Approximately 5% of those stung (about 1 in 20 people), insect stings can cause allergic reactions including the following symptoms: hives, itching, swelling, chest tightness,  dizziness and/or more serious forms of anaphylaxis including: tongue swelling, stomach cramps, nausea, diarrhea and  life threatening drop in blood pressure. Anaphylaxis is an emergency that requires immediate attention. Following treatment in the emergency room, an Allergist should be consulted without delay.

Identifying stinging insects
Most sting reactions are caused by yellow jackets, honeybees, paper wasps, hornets and fire ants. To avoid being stung, it is important to learn what these creatures look like and where they live.

Yellow jackets
are black with yellow markings. Their nests are usually located underground, but can sometimes be found on the walls of buildings, cracks in stonework or buried in wood piles. The nest are roughly the size of a baseball and may be exposed or below ground. Yellow Jackets are smaller than hornets and paper wasps, about the same size as a honeybee (which they are often confused with). 
yellow jacket yellow jacket nest


Honeybees
have a round fuzzy bodies with dark brown and yellow markings. Honeybees usually leave a barbed stinger in victims, causing the death of the bee. Honeybees are not aggressive, only stinging if provoked. Wild honeybees live in colonies, called honeycombs, in the hallow part of trees or crevices in buildings.
honey bees honey bee nest


Africanized honeybees
, or “killer bees” are more aggressive and may sting in swarms.  They nest in partially protected areas, such as holes in house frames and old tires or holes in the ground.
Paper wasps' have long, slender bodies. They may be brown, black, or red with yellow markings. Their nests circular paper-like combs that open downward and are usually built under eaves, in shrubs or wood piles or behind shutters.


Hornets
belong to the wasp family if insect.  They are black or brown with white, orange or yellow markings.  Their nests are gray or brown, football-shaped, and made of a paper materials. Hornets' nests are usually found high above ground on tree branches, on gables or in tree hollows.
hornets hornets nest


Fire ants,
named for the burning sensation caused by their sting, are reddish brown to black in color. They build nests of dirt in the ground that may be as tall as eighteen inches.  Fire ants are aggressive and may attack without warning. The fire ant may inflict multiple stings in a circular pattern. Fire ant venom often causes an immediate burning sensation.
fire ant fire ant nest

Preventing stings
Insects are most likely to sting when their nests are disturbed.  Identifying and avoiding nests and eliminating nests found around your home is an important measure in avoiding insect stings.  Since identifying and removing nests can be dangerous, it may be necessary to hire a trained professional. 

Insects are attracted to bright colors and sweet scents.  To avoid them avoid perfumes and brightly colored cloths.  Wear shoes with closed toes when outdoors.  Cover food when eating outside and avoid loose fitting clothing that can trap an insect inadvertently. 

Treating stings

If you are stung by a honeybee remove the stinger immediately.  If there is a sac attached to the stinger, this may contain additional venom.  Avoid putting pressure on the sac which could force more venom into the skin.  Since wasps do not loose their stingers, they may sting more than once.  Gently but firmly push these insects away in a broad sweeping motion to avoid being stung more than once.  If you are stung by a fire ant, carefully brush it off and leave the area. Fire ant stings usually result in blisters which develop within about 24 hours. These blisters may appear cloudy, but rarely contain pus.  Fire ant venom has antibiotic properties, so popping the blister increases, rather than decreases, the risk of infection.  Rupturing the blister should be avoided.  If left alone, blisters will dry and heal, usually within a week. About half of the people who are stung by fire ants develop a local reaction that may persist for several days and can include swelling, itching, redness and pain. 

Taking the following steps when treating local reactions to insect stings:
   •     Elevate the affected area and apply ice or cold compresses.
   •     Clean blisters with soap and water, but avoid rupturing the blister.
   •     Apply topical steroids, when necessary, to reduce itchiness.
   •     See your doctor if swelling increases or signs of infection are present.

If your allergy is severe, carry an injectable epinephrine (adrenalin) device and learn how to self-administer the epinephrine according to your allergist's instructions. Epinephrine is not a substitute for immediate medical attention.  If you have a history of anaphylaxis in response to an insect sting and you are stung by an insect, you should be seen in an emergency room immediately.  You should also consider wearing a medical alert bracelet.

If you have questions about venom immunotherapy (allergy shots) or other treatments for stinging insect allergy, be sure to ask your allergist. Patients who receive appropriate treat­ment such as immunotherapy (allergy shots) and who practice careful avoidance measures can participate in regular outdoor activities.

An allergist should be consulted if
you have had a reaction due to insect stings , especially if the reaction was systemic, so that the specific allergen can be identified and to evaluate the need for immunotherapy (allergy shots) to protect you from future anaphylaxis.

Copyright © 2008-2010 Dr. Beth Cowan