Annals Of Occupational Hygiene

Abstract

Management of Insect Sting Hypersensitivity: An UpdateReactions to Hymenoptera insect stings are very common and can result in local allergic reactions, systemic allergic reactions or anaphylaxis, and occasionally death.The Hymenoptera insects responsible for most stings are in the family Vespidae (wasps), family Apidae (bees), and family Formicidae (ants).Proper identification of the responsible insect by physical appearance or nest construction can help to direct care.The purpose of this article is to provide an update regarding the diagnoses, acute management, and long-term preventative options for common insect stings.As many as 94% of adults report at least 1 Hymenoptera sting in their lifetime.In a study of 3,236 Hymenoptera allergic subjects in North America, the subjects averaged 2.7 stings during their lifetime, and 89% reported at least 1 systemic allergic reaction.The prevalence of allergic reactions after a single sting is 0.15% to 0.8% among children and 0.3% to 8.9% among adults.Insect sting-related anaphylaxis accounts for more than 30% of all anaphylaxis cases seen in emergency departments, and for 20% of all anaphylaxis-related deaths.There are 3 possible reactions after a Hymenoptera sting: a local reaction, a large local reaction, or a systemic reaction.Local reactions present with localized pain, swelling, and erythema at the site of the sting and resolve quickly.Large local reactions peak within 48 hours and may take weeks to completely resolve.Recommended treatment includes ice pack application, elevation of the affected area, and oral antihistamines or systemic corticosteroids, or both.The first-line treatment for severe systemic reactions includes subcutaneous epinephrine (1:1,000 solution) 0.01 mg to 0.3 mg for children and 0.3 mg to 0.5 mg for adults, and can be repeated as clinically indicated.The H1 and H2 antihistamines, glucocorticosteroids, oxygen, bronchodilators, and intravenous volume expanders are also recommended.Any patient with a systemic reaction should be prescribed an epinephrine pen upon discharge.Patients with a reported systemic reaction to a Hymenoptera sting can undergo skin prick tests or intradermal skin tests to identify their immunoglobulin E antigen.Venom immunotherapy is recommended for adults or children who have systemic reactions and evidence of immunoglobulin E antibodies, children who have large local reactions or systemic reactions to fire ants in endemic areas, and adults with large local reactions who are high risk for being stung again.Venom immunotherapy successfully prevents future systemic reactions in 75% to 95% of persons.Hymenoptera stings are extremely common, especially in outdoor environments, and it is essential to correctly diagnose and manage acute allergic reactions to reduce their associated morbidity and mortality.