I was stung and had a reaction! Do I need to see an allergist?

Late summer is the time for yellow jackets, wasps, hornets and honey bees to be active. Most insect stings will cause a local reaction (pain, redness and swelling at the sting site) lasting a day or so. Sometimes, the reaction is more than that and the question arises, do I need to see an allergist?

Here is a simple check list to assist you in making decisions.

When to go to the ER or call 911:

• Feeling of “impending doom,” loss of consciousness, shock (low blood pressure), dizziness, seizure

• Lower Respiratory: difficulty breathing, wheezing, chest tightness, coughing or shortness of breath

• Upper Respiratory: tongue or throat swelling, difficulty swallowing, talking or breathing

• Skin: persons over 16 years old with generalized hives (welts), swelling, itchiness, flushing

• GI: cramps, abdominal pain, vomiting, diarrhea

When to see an allergist:

Allergic reactions to stings can occur at any age, even after many normal reactions to stings. Any person who has experienced one or a combination of the above symptoms should be evaluated by an allergist. The single best predictor of the outcome of a future sting is still the severity of the previous sting reaction. It is estimated that potentially life threatening reaction occur in 0.4% to 0.8% of children and 3% of adults.

A person who has experienced recurrent large local reactions (swelling, redness that extends well beyond the sting site), spends considerable amounts of time outdoors where stinging insects are present and has needed recurrent courses of oral steroids (prednisone) for treatment. The risk of a systemic reaction in patients who experience large local reactions is about 5-10%.

Why see an allergist?

Allergy injections to the insect venom (called venom immunotherapy or VIT) are a very effective treatment and can decrease the risk of a future severe allergic reaction to less than 5% for many patients. If not treated with VIT, up to 60% of patients if re-stung will have a severe reaction. Venom allergy skin testing combined with blood IgE to the specific venom can determine which insect is the problem and help differentiate a toxic reaction or other non-allergic reaction from a true allergic reaction. In addition, a blood test for tryptase will be done. If the tryptase level is elevated, there is an increased risk of severe reaction to an insect sting, increased chance of reaction to VIT, failure of VIT and increased risk of severe reaction after VIT is stopped.

Venom immunotherapy should include all venoms that are positive. The recommended dose for each venom protein is 100 mcg. This is equivalent to the venom content of 2-4 insect stings. The amount of venom injected by a honeybee sting is about 50 mcg; however, the amount of venom injected by other vespids is in the range of 2–20 mcg per sting.

More than 5% of the population has insect sting allergy, yet few patients are referred for diagnostic testing and specific treatment. At Family Allergy Asthma & Sinus Care, we specialize in sorting out the reaction and offer state-of-the-art approaches for diagnosis and treatment of insect sting reactions. Why? We want our patients to BEE healthy and happy!