Allergy to Stinging Insects: Diagnosis and Management

Abstract

Stinging insects that cause allergic reactions belong to the order Hymenoptera, which includes wasps, hornets, bees, yellow jackets, true hornets, and stinging ants. Individuals stung by these insects can have different clinical outcomes, from common local reactions to severe systemic reactions. Anaphylaxis as a result of insect stings can result in death; therefore, individuals with a history of systemic reaction to stings should be further evaluated and treated. A history of systemic reaction to insect stings and immunoglobulin E sensitivity to specific insect venoms, determined by blood or skin testing, are criteria for venom immunotherapy administration. Venom immunotherapy modulates the immune system to make the recipient less sensitive to venom and can be curative. All individuals with a history of systemic reaction to insect stings should be provided with an adrenaline auto-injector and educated in avoidance measures to prevent future stings. This review will discuss the diagnosis of venom allergy, the management of venom allergic individuals with venom immunotherapy, and identification of risk factors for severe anaphylaxis to insect stings. This review will also aid clinicians in discussing avoidance measures with patients.