Allergies to Insect Stings

Treatment Overview

Key treatment points

• For normal reactions to insect stings, medical treatment is usually not needed. An ice pack or cold compress may reduce swelling and pain, along with taking a nonprescription pain reliever, such as acetaminophen.
• If you have a large local reaction that spreads around the sting or affects an entire limb, taking an antihistamine can reduce your overall symptoms.
• Systemic allergic reactions involve your whole body and are considered a medical emergency. If you have had a severe systemic reaction to an insect sting in the past, carry an allergy kit with you so that, when stung, you can immediately treat yourself with the antihistamine tablet and epinephrine injection from the kit. Always seek emergency care after an epinephrine injection—your symptoms could reappear or become worse for several hours after the first epinephrine injection.
• If your systemic reaction gets worse, you may develop anaphylaxis, which is a life-threatening response to the insect venom. Emergency medical attention is needed. Call 911 or seek immediate treatment in a hospital emergency room. Medicines will be given to reduce swelling, open your airway to help you breathe, and stabilize your blood pressure.

Allergies to insect stings are treated by avoiding the insects that cause the allergy, treating mild cases with medicines such as antihistamines, and understanding how and when to use an allergy kit for serious reactions.

Special care must be taken with children who have insect sting allergies. A child with a severe allergy may have life-threatening anaphylactic reactions to even tiny amounts of venom from the insect. Your child should always wear a medical alert bracelet and carry an allergy kit. Children at risk for severe allergic reactions should keep allergy kits at school or day care as well as at home. Make sure that all caregivers—such as school administrators, teachers, friends, and coaches—know about the insect sting allergy, where the allergy kit is kept, and how and when to give the epinephrine injection. Also, make sure they have a plan to transport your child to the hospital. Older, mature children should be taught to give self-injections.

Allergies: Giving yourself an epinephrine shot

Immediate treatment for an allergic reaction to an insect sting depends on the type and severity of your symptoms.

Normal reaction to insect stings

For the normal reaction that most people have to a sting, medical treatment is usually not needed. An ice pack or a cold compress and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen may relieve some of the swelling and pain, nonprescription pain relievers such as acetaminophen (for example, Tylenol) may reduce pain, and oral antihistamines such as diphenhydramine (for example, Benadryl) can reduce itching.

Large localized allergic reaction

Treatment for large local allergic reactions usually consists of:

• Cold compresses or ice packs, to reduce swelling and local pain.
• Elevating the limb (if this is where the sting occurred), to reduce swelling.
• Nonsteroidal anti-inflammatory drugs (NSAIDs), to reduce swelling and pain.
• Nonprescription pain relievers such as acetaminophen, to reduce pain.
• Antihistamines, which can reduce overall symptoms.
• Anesthetic creams or ointments, which may reduce pain and itching.
• Corticosteroids (such as prednisone), which can reduce swelling and pain. (The use of corticosteroids to treat local allergic reactions is controversial.)

Systemic allergic reactions

Systemic (whole-body) allergic reactions to a sting are considered a medical emergency. Immediate treatment is needed and may include:

• An injection of epinephrine.
• An antihistamine, which may be given along with the injection of epinephrine.
• Oral or intravenous (IV) corticosteroids.

Allergies: Giving yourself an epinephrine shot

Allergies in children: Giving an epinephrine shot to a child

Treatment for anaphylaxis—the most severe systemic allergic reaction, one that can be life-threatening—is designed to keep your airway open and relieve other breathing or heart problems that can occur, especially if there are signs of shock. In addition to epinephrine and an antihistamine, treatment for anaphylaxis may include:

• Bronchodilators, to reduce breathing difficulties.
• Corticosteroids (such as prednisone), to help decrease inflammation.
• Intravenous (IV) fluids, to stabilize blood pressure.

If anaphylaxis is prolonged, medicines to stabilize blood pressure and other measures to help with breathing—such as oxygen, intubation, and possibly a ventilator—may be needed.

If you had anaphylaxis, you will normally need to stay in the hospital for 8 to 12 hours before being released. Symptoms of anaphylaxis can recur after several hours, so you may need additional medicine or treatment.

Long-term treatment

If testing and examinations confirm that you are allergic to insect stings, long-term treatment usually includes:

• Avoiding or preventing stinging insects. You can reduce your chances of being stung by avoiding areas where insects nest; wearing shoes, long sleeves, and long pants when you are outdoors; and not wearing perfume or scented lotions.
• Carrying an allergy kit. The kit contains emergency medication, including antihistamine tablets and an epinephrine injection that you can immediately self-administer if you are stung. Talk with your doctor about how to store your kit and when and how to give yourself the injection.
• Wearing a medical alert bracelet or medallion. At most pharmacies or on the Internet, you can purchase a medical alert bracelet or other jewelry that lists your insect sting allergies. Medical alert jewelry quickly alerts emergency response workers to your allergy. This helps them provide immediate and appropriate treatment.

Allergies: Giving yourself an epinephrine shot

Allergies in children: Giving an epinephrine shot to a child

If you have a history of systemic allergic reactions, you may consider treatment with a series of shots (immunotherapy) to reduce your sensitivity to the stinging insect's venom and lower your risk of a severe reaction. Immunotherapy is usually not needed for adults or children who have only a large local reaction to a sting. But anyone who experiences increasingly severe large local reactions with each new sting may want to consider immunotherapy. Talk with your doctor or allergy specialist to see whether immunotherapy is appropriate for you.

Should I have allergy shots (immunotherapy) for allergies to insect stings?

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Author:	Caroline Rea, RN, BS, MS	Last Updated: January 22, 2008
Medical Review:	William M. Green, MD - Emergency Medicine Harold S. Nelson, MD - Allergy and Immunology
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