What Is Insect Sting Anaphylaxis?

Insect sting anaphylaxis is a severe, life-threatening allergic reaction that occurs after being stung by certain insects. This reaction involves the entire body, not just the sting site, and requires immediate emergency treatment. It is a medical emergency and can be fatal if not treated quickly.

What Insects Can Cause Anaphylaxis?

Anaphylaxis is typically triggered by venomous stings, not bites. The main insects associated with this condition include:

• Bees
• Wasps
• Hornets
• Yellow jackets
• Fire ants

These stings inject venom that can trigger an intense immune response in allergic individuals.

What Happens During Anaphylaxis?

Anaphylaxis is a rapid, systemic allergic reaction that may occur within minutes of the sting. The immune system releases a flood of chemicals that cause:

• Swelling of the airways
• Sudden drop in blood pressure
• Shock
• Multiple organ involvement

Without immediate treatment, it can lead to loss of consciousness, cardiac arrest, or death.

What Are the Symptoms of Insect Sting Anaphylaxis?

Symptoms may appear within seconds to minutes after the sting. They include:

Skin:

• Hives or itching
• Flushing or pale skin
• Swelling of the face, lips, or tongue

Respiratory:

• Difficulty breathing
• Wheezing
• Tightness in the chest or throat
• Hoarseness

Cardiovascular:

• Rapid or weak pulse
• Low blood pressure
• Dizziness or fainting

Gastrointestinal:

• Nausea or vomiting
• Abdominal cramps
• Diarrhea

Neurological:

• Confusion
• Sense of doom
• Loss of consciousness

Even if symptoms seem mild at first, anaphylaxis can escalate quickly, so treatment should never be delayed.

How Is Insect Sting Anaphylaxis Diagnosed?

Diagnosis is based primarily on:

• History of a sting followed by systemic symptoms
• Physical examination during or after the reaction
• Blood tests (e.g., tryptase levels, if taken shortly after the reaction)
• Allergy testing later, including skin or blood tests to identify specific insect venom sensitivities

Patients with a history of anaphylaxis should be referred to an allergist or immunologist for further evaluation.

How Is Insect Sting Anaphylaxis Treated?

Immediate Treatment:

• Epinephrine injection (EpiPen) is the first and most important treatment
• Call emergency services immediately (even if symptoms improve)
• Lie the person down with legs elevated unless breathing is difficult
• In a medical setting, additional treatments may include:
  • Oxygen therapy
  • IV fluids
  • Antihistamines and corticosteroids
  • Beta-agonists for breathing support

Delaying epinephrine increases the risk of complications and death.

Ongoing Management:

• Prescription of epinephrine auto-injectors for emergency use
• Education on how and when to use epinephrine
• Creation of an allergy action plan
• Referral for venom immunotherapy (allergy shots) to reduce future risk

Can Insect Sting Anaphylaxis Be Prevented?

Yes, with careful planning and awareness:

• Avoid areas where stinging insects are common
• Wear protective clothing outdoors
• Do not swat at insects, which can provoke stings
• Keep food and drinks covered when eating outside
• Avoid wearing strong perfumes or bright-colored clothing
• Carry two epinephrine auto-injectors at all times if you are allergic
• Consider venom immunotherapy – proven to reduce the risk of future severe reactions

Who Is at Risk of Insect Sting Anaphylaxis?

You may be at higher risk if you:

• Have had a previous allergic reaction to an insect sting
• Have other allergies or asthma
• Are male and over age 40 (higher risk of severe reactions from stings)
• Work or spend time outdoors in gardens, farms, or wooded areas
• Have no prior history but develop sudden allergic symptoms after a sting

It’s important to seek medical evaluation after any systemic reaction to a sting.

What’s the Outlook for People with Insect Sting Anaphylaxis?

With proper management, people with insect sting allergies can lead safe and normal lives. Key to a good outcome includes:

• Rapid use of epinephrine during emergencies
• Understanding personal triggers
• Avoidance strategies
• Long-term treatment with venom immunotherapy, which can reduce severe reactions by up to 98%