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How Referral to an Allergy/Immunology Physician can Help in the Diagnosis and Management of Stinging Insect Allergy
Patients who have had severe generalized reactions to an insect sting should be referred to an allergist/immunologist for allergy testing to identify the offending insect(s) and discuss immunotherapy (allergy shots). Allergy shots utilize the venom of the stinging insect, except in the case of fire ants (when an extract of the whole-body is used.)
Why:
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As many as 3% of individuals are at risk for a severe allergic reaction (known as anaphylaxis) to insect stings. In the U.S. there are approximately 40 deaths every year from allergic reactions to insect stings.
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Patients are often wrong about which type of insect (for example, yellow jacket vs. wasp) caused their allergic reaction.
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By having allergy tests to stinging insects, patients can have a better understanding of the insect(s) which cause their allergic reactions. This can help with treating the reaction and avoiding future reactions.
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Allergy skin tests are generally preferred over blood tests when first evaluating a patient for allergy to insect venoms.
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Patients with insect sting allergy can receive allergy shots to venoms (or whole body extract in the case of fire ant allergy) which can significantly reduce the risk of another severe reaction the next time they are stung.
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Allergy shots may reduce the risk of dying from a future sting in patients with insect sting allergy.
How the Allergist/Immunologist Can Help with Allergic Reactions to Insect Bites
Patients who have had severe generalized reactions to biting insects should be referred to an allergist/immunologist to help identify the offending insect(s).
Why:
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Biting insects such as Triatoma species (kissing bugs) and mosquitoes can cause severe allergic reactions which can affect multiple body systems at the same time.
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Blood or skin tests to the allergic proteins in Triatoma and other biting insects can be used to identify whether a patient has allergic antibodies to those insects in their bloodstream.
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The allergist/immunologists can provide patients with information about underlying causes for their allergy, tips to avoid future bites, and how to manage both mild and severe reactions to any future bites. This can help minimize worry about reactions and potentially reduce side effects or complications from future bites.
How the Allergist/Immunologist Can Help Manage Patients Who are Taking Allergy Shots for Allergy to Stinging Insects
Patients who receive allergy shots for stinging insects should see an allergist/immunologist once a year to review their progress on their shots, update their medical history, and discuss how long their shots should be continued or whether repeat testing is necessary.
Why:
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Reviewing a patient’s updated medical history and allergy shots (including doses, schedule, and any abnormal reactions) on a regular basis may reduce complications of treatment.
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Regular review may identify new health problems or medications that could increase the risk of problems from stings or allergy shot reactions.
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The allergist can evaluate any stings the patient may have had since starting allergy shots, which helps to determine how well the shots are working and whether any changes to the shot dose or frequency should be made.
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The time between maintenance dose injections can be increased to every 4 weeks during the first year of allergy shots and eventually to every 6-12 weeks in some patients.
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Many patients can safely discontinue venom allergy shots after at least 3-5 years of treatment, although some patients may need to continue immunotherapy long-term or even life-long. An allergist/immunologist who specializes in treating patients with insect sting allergy can best facilitate individualized patient decisions.
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