Allergy
Stinging Insect Allergy
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Stinging Insect Allergy
, Hymenoptera Allergy
See Also
Insect Bite
Epidemiology
Responsible for at least 50 U.S. fatalities yearly
Incidence
of systemic reaction to
Stinging Insect
Adults: 3%
Children: 1%
Background
Usually only
Insect
s of Hymenoptera cause
Anaphylaxis
Distinct
Insect
Venom
s (allergy specific to types)
Honeybee and Bumblebee
Venom
Yellow Jacket and Hornet
Venom
Polistes
Wasp
Fire ants
Signs
See
Allergic Reaction
Systemic reactions (IgE mediated)
Anaphylaxis
Large local swelling at bite (8-10 inch diameter)
Develops over 2 days
Resolves within 7 days
Differential Diagnosis
See
Insect Bite
Diagnosis
Hymenoptera venom tests
Intradermal Test
ing
Requires each venom type be tested (see background)
Venom
dose varies from 0.001 to 1.0 mcg/ml
Do not test without history of reaction
Test Sensitivity
: 65-80%
False Negative
s: Too early after bite (<6 weeks)
RAST
testing
May be useful to clarify
Skin Testing
Sensitivity level does not correlate with reaction
Management
See
Anaphylaxis
Prevention
See
Allergic Reaction
See
Insect Bite
See
Prevention of Vector-borne Infection
Immunotherapy
with venoms
Protects in 98% of cases against severe reaction
Mixed vespid venom higher efficacy than individual
Local reactions occur in 50% of patients
Most often occurs at starting doses <50 mcg
Titrate up to maintenance dosing
Individual venom: 100 mcg
Mixed vespid venom: 300 mcg
Continue maintenance for at least one year
Once on full dose, dose monthly
May ultimately be spread to every 6-8 weeks
Monitoring during Desensitization
Consider skin retesting every 2-5 years
Venom
skin tests after
Desensitization
Negative at 5 years: <20% of cases
Negative at 7-10 years: 50-60%
Prognosis
Future risk of systemic reaction
Skin-test confirmed recurrence risk declines with time
Initially: 50%
Year 3-5: 35%
Year 10: 25%
Risk decreases with duration of
Desensitization
Reactions uncommon on
Desensitization
maintenance
Reactions after
Desensitization
are usually more mild
Desensitization
stopped <2 years: High reaction risk
Desensitization
stopped 5 years: 10% reaction risk
Resources
AAAAI Stinging Insect Allergy Prevention
http://www.aaaai.org/patients/publicedmat/tips
References
Golden (2003) Am Fam Physician 67(12):2541-6 [PubMed]
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