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Stinging Insect Allergy

Presentation Overview

§  Epidemiology and Prevalence §  Identifying and Characteristics of Insects §  Reactions §  Diagnosis §  Treatment/Immunotherapy

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Epidemiology

§  May develop at any age

§  Usually manifests after several uneventful stings

§  Males > females (? increased exposure)

§  Family history does not increase risk

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The Stinging Insects

Identifying them and their characteristics

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Hymenoptera

Honeybee Bumblebee Yellow jacket species Yellow hornet, white-faced hornet European, oriental hornets Paper wasp species Fire ants

Common Names Apis Bombus Vespula Dolichovespula Vespa Polistes Solenopsis

Bees Vespids Ants

Genus

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Apidae Family

§  Wild: tree hollows, old logs

§  Domestic: commercial hives

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Apidae Family §  Leave barbed stinger and

venom sac after sting, dies:

§  “Sting autonomy”

§  50 µg venom per sting (up to 140 µg)

§  Venom sacs ~300 µg

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Vespids §  Yellow jackets, hornets, wasps §  Feed on human foods (sweet) §  Finer barbed stinger, can sting multiple times §  Extensive venom cross-reactivity §  Nests: layers of comb

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Yellow Jackets §  Ground dwellers

–  Yard work, gardening, farming –  Wall tunnels, crevices, hollow

logs §  Very aggressive, sting with

minimal provocation (food) §  Most common sting §  10-100 µg venom per sting §  Late summer §  Attracted to food

–  Sting in mouth

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Hornets §  Related to yellow jackets §  Genus: Dolichovespula §  Extremely aggressive, especially

around nest. Chase! §  Large nests in trees and shrubs §  Sensitive to vibration §  2.4-5 µg venom per sting

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Wasps

§  Genus: Polistes §  Narrow waist §  Honeycomb nests in shrubs,

under eaves of houses or barns, window sills, patio furniture, playgrounds, dryer vents

§  Scavengers: outdoor events, food and drink

§  4.2-17 µg venom per sting

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Formicidae Family

§  Sting multiple times in circular pattern by anchoring mandibles and pivoting

§  Sterile pseudopustule pathognomonic (24 hours); necrotic tissue. Should be left intact. Secondary infection most common complication

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Management

§  Referral to an allergist §  Avoidance §  Emergency epinephrine: teach how to administer and under

what circumstances; repeat dosing §  Venom immunotherapy §  Consider medical alert bracelet or necklace

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Avoidance Measures

§  Exterminate known or suspected nests; periodic surveillance §  Avoid wearing brightly colored clothing or flowery prints §  White and light colors are best §  Avoid strongly scented material §  Wear shoes outside

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Avoidance Measures

§  Wear long pants, long-sleeved shirts, socks, head covering, work gloves, and hats

§  Caution around bushes, eaves, attics, garbage containers, picnic areas

§  Insecticides (not affected by insect repellants) §  Caution when eating or drinking outdoors

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What Bees See

Our eyes Bees eyes seeing ultraviolet

Bees see UV, blue and green

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Diagnosis

§  History: identification, bring the insect to clinic –  Activity, location, type of insect activity in the area, number of

stings, sting site, timing of symptoms, visual identification, emergency treatment, risk of repeated stings, reactions to subsequent stings

–  Presence of a stinger?

§  Skin testing

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Venom Immunotherapy (VIT)

§  Extremely effective in reducing risk of subsequent systemic reaction (95-97%)

§  Milder reactions

§  Duration of treatment –  3-5 years (4-5 years fire ant) –  Indefinitely

•  History or severe anaphylaxis with shock or loss of consciousness

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