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Allergy & Asthma Advocate: Summer 2007
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Allergy & Asthma Advocate: Summer 2007
Venom AllergyBy Andy Nish, MD, FAAAAI
Insect stings can cause a potentially life-threatening reaction in approximately three percent of people. This article will inform you about allergy to stinging insects and the treatments available for this disease.
Bug bites, as opposed to stings, from insects such as mosquitoes are rarely associated with severe reactions. Insects in the Hymenoptera order use their stingers to inject venoms. Insects primarily associated with venom allergy are hornets, yellow jackets, wasps and honeybees. Imported fire ants can also cause severe reactions in temperate regions of the United States. Stings from other insects such as scorpions have rarely caused allergic reactions. In most people, insect stings cause local pain, swelling, redness and sometimes itching. These symptoms, called a local reaction, can sometimes last for days and the redness can extend for some distance. As long as other symptoms do not accompany these local reactions, it is believed that these reactions do not place someone at increased risk for anaphylaxis from insect stings. Anaphylaxis is a severe generalized potentially life-threatening allergic reaction.
Symptoms of anaphylaxis in the respiratory system include wheezing, coughing, shortness of breath and chest tightness. Anaphylaxis can also include throat closing, urticaria or hives, angioedema or swelling including lips, face and tongue. Other symptoms can be nausea and vomiting, and uterine cramping in women. Anaphylaxis is a life-threatening emergency and medical care should be sought immediately.
If anyone has experienced anaphylactic symptoms after an insect sting, he or she should seek the care of an allergist. The diagnosis of stinging insect allergy is made first by taking a careful history regarding reaction(s). If the allergist decides that testing is necessary, skin tests are typically done first in a standardized fashion. Studies have shown us the best ways to test, for which insects to test, and doses to use in testing. If there is any uncertainty after skin testing is done, then blood tests, or RAST tests may be added also to aid in diagnosis.
Once someone has been diagnosed with venom allergy, there are three areas of treatment. The first is avoidance. It is recommended to be careful in outdoor areas and particularly around picnics and trash. Avoid brightly-colored clothing and perfumes or colognes and always wear shoes outdoors. Have someone else check around your home for the presence of insects to which you are allergic and, if present, use appropriate methods to remove them.
Those with venom allergy should always have on hand injectable epinephrine, or adrenaline, usually in the form of Twin-Ject or Epi-Pen. These are auto-injectors which inject epinephrine into the body to help counteract anaphylaxis. It is vitally important that you receive instruction in proper use of these medications, both when and how to use, prior to a reaction. It is recommended that you consult with your allergist for specific advice, but in general you should use your device for symptoms of anaphylaxis and go to the emergency room. These devices need to be stored at room temperature as excessive heat, such as that in a car, may cause them to lose effectiveness.
As important as it is to have epinephrine on hand, the best treatment for venom allergy is immunotherapy, or venom shots. There are good venom extracts available for the flying Hymenoptera and also imported fire ants. Venom shots are given as initially small amounts which are increased in amount and strength over time. These are usually given at first once or twice a week, then less frequently as treatment progresses. Your allergist will discuss specific recommendations with you.
Well-controlled studies have shown venom immunotherapy to be 98% protective against future anaphylactic reactions once maintenance is achieved. Venom shots are recommended to be continued for five years in most cases. Again, your allergist may have different recommendations based on your specific circumstances.
In summary, allergy to stinging insects can be life-threatening and may affect a large number of people. Venom allergy should be thoroughly evaluated and treated by an allergist with the highly effective testing and treatment available.
For more information, including local allergists, go to the AAAAI Web site at, www.aaaai.org.
© 1996-2008 · All Rights Reserved · American Academy of Allergy Asthma & Immunology
