hymenoptera (insect) sting
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Pathology
- IgE cross-reactive with venoms of yellow jackets, wasps & hornets but not cross-reactive with venom of bees
- systemic reaction (anaphylaxis, angioedema) in < 7% of people who are stung
- 25% of people have large local reaction[3]
Clinical manifestations
- normal reaction following any sting or bite
- immediate local pain with swelling
- subsides within 1-2 hours
- pruritus that may persist for days
- large local reaction
- swelling extending from sting site over large area
- peaks at 48 hours, may persist up to 1 week
- manifestations of corneal bee sting
- may range from mild irritation to loss of vision (case report)[6]
- corneal haziness due to corneal edema
- stinger may remain embedded in cornea
Laboratory
- venom-specific IgE
- leukocytosis & hyperglycemia typical of stress reaction
- baseline serum tryptase can identify patients at high risk for anaphylaxis & those with mastocytosis[4]
- allergen skin testing*
- indicated only for systemic reaction (anaphylaxis, angioedema)
- not indicated after large local reaction[3]
- specific IgE antibodies to Hymenoptera venom in 40% of the general population[3]
- delay for one month after sting
- indicated only for systemic reaction (anaphylaxis, angioedema)
* Hymenoptera venom skin testing
Complications
- anaphylaxis
- corneal bee stings may result in corneal injury & secondary glaucoma (case report)[6]
Management
- local reaction
- cool compresses
- topical lotions
- secondary infection treated as cellulitis with antibiotics
- antihistamines
- chlorpheniramine 4-8 mg every 6 hours
- diphenhydramine 50 mg PO every 6 hours
- prednisone 40 mg PO for 2-3 days
- corneal bee sting
- moxifloxacin ophthalmic with stinger removed under local anesthesia (case report)[6]
- cleanse anterior chamber,suture as needed
- 2-week course of topical glucocorticoid, antibiotic, & cycloplegic
- treat anaphylaxis
- patients with history of systemic reaction should carry insect sting kit
- venom immunotherapy[2]
- small risk of inducing anaphylaxis with immunotherapy
- patients must still carry insect sting kit
- indications
- history of anaphylaxis to hymenoptera sting + positive skin testing to hymenoptera venom[3]
- patient anxiety disrupts activities of daily living
- occupational risk
- house painter
- outdoor construction worker
- forestry workers
- 5 years of venom immunotherapy[4]
- sting challenges most reliable way to determine effectiveness of venom immunotherapy[5]
More general terms
Additional terms
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1172-74
- ↑ 2.0 2.1 Journal Watch 24(19):154-55, 2004 Golden DB, Kagey-Sobotka A, Norman PS, Hamilton RG, Lichtenstein LM. Outcomes of allergy to insect stings in children, with and without venom immunotherapy. N Engl J Med. 2004 Aug 12;351(7):668-74. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15306668
Gruchalla RS. Immunotherapy in allergy to insect stings in children. N Engl J Med. 2004 Aug 12;351(7):707-9. No abstract available. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15306673 - ↑ 3.0 3.1 3.2 3.3 3.4 Amrol DJ NEJM Journal Watch. July 3, 2014 Massachusetts Medical Society (subscription needed) http://www.jwatch.org Sturm GJ et al. Sensitization to Hymenoptera venoms is common, but systemic sting reactions are rare. J Allergy Clin Immunol 2014 Jun; 133:1635 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24365141 <Internet> http://www.jacionline.org/article/S0091-6749%2813%2901707-7/abstract
- ↑ 4.0 4.1 4.2 Golden DB, Demain J, Freeman T et al. Stinging insect hypersensitivity: A practice parameter update 2016. Ann Allergy Asthma Immunol 2017 Jan; 118:28. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28007086 <Internet> http://www.annallergy.org/article/S1081-1206(16)31270-4/abstract
- ↑ 5.0 5.1 Anello J, Feinberg B, Heinegg J et al Hymenoptera Venom Allergy Guidelines on hymenoptera venom allergy immunotherapy by the European Academy of Allergy and Clinical Immunology. Medscape: New Guidelines and Recommendations, August 2017. http://reference.medscape.com/viewarticle/884517
- ↑ 6.0 6.1 6.2 6.3 Mendonca TM, Rodrigues GR Images in Clinical Medicine: Corneal Bee String. N Eng J Med. 2020. Nov 28 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33252203 https://www.nejm.org/doi/full/10.1056/NEJMicm2024132