Stinging Insect Allergy

Dr Lacey Robinson of the Allergy and Clinical Immunology Unit discusses allergy to stinging insect venoms.

Who We Treat

Patients typically contact our division because they have developed an acute reaction to an insect sting. Our role is to determine whether this is:

• A potentially life-threatening, systemic allergic reaction (i.e. one that affects the whole body), or
• A large, localized reaction (i.e. major swelling restricted to one area of the body)

If we establish the patient has had a local reaction, then no further testing is necessary because future insect stings will not carry increased risk of systemic allergic reactions. The itching and pain associated with local reactions can be treated with various over-the-counter medications, creams and lotions.

What to Expect

In our division, we evaluate and treat patients who have experienced a systemic allergic reaction to an insect sting.

At your first appointment, you can expect an in-depth consultation with one of our allergists. If we suspect you have had a systemic allergic reaction, we will arrange for blood testing to look for evidence of allergy to these venoms. On occasion, we may have you return for allergen skin testing to determine which type of insect might be responsible. The testing involves safely exposing you to specific insect venoms.

If we confirm you have had a systemic reaction and are allergic to certain insect venoms, we will prescribe allergy shots with the appropriate insect venom(s). Allergy shots are conducted in two phases. During the build-up phase, gradually increasing doses are administered to establish tolerance. This can be done rapidly over a few days or gradually on a weekly basis after discussion between the patient and physician to determine the protocol that is most suitable for the patient. After the build-up phase, the patient enters the maintenance phase during which visits are scheduled once a month (which is known as the "maintenance period"). Your safety is always our first priority. After each shot, you will stay in our office for about 30 minutes, so we can monitor you for adverse reactions.

During the maintenance period, you will receive an amount of venom equivalent to several insect stings with each shot. As a result, you will know you can tolerate actual stings should they occur in the wild. Treatment typically lasts three to five years to promote long-lasting protection from future systemic reactions. Some patients who have had a life-threatening reaction from a stinging insect or have certain risk factors may be advised to continue immunotherapy indefinitely.

If we determine you are an extremely high-risk case, "rush immunotherapy" may be appropriate. This type of treatment involves rapidly escalating the dosing in your shots to build up your tolerance in a matter of days.

Avoidance Strategies

While allergy shots are very effective, it is important that you become educated about your allergic condition. Our nurses will carefully explain avoidance strategies, such as not wearing perfumes or brightly colored clothing, and staying away from locations where nests or hives are likely to be present.

We will also teach you how to use self-injected epinephrine. During your first six months of treatment (before you reach the maintenance dose), you will still be vulnerable to insect stings. In order to reduce the risk of a systemic allergic reaction, it is important that you are prepared to use your epinephrine device quickly and properly.

Rebecca Saff, MD, PhD, of the Allergy and Immunology Unit, discusses anaphylaxis.

Identifying & Treating Those at Risk

Only five types of stinging insects cause allergic reactions in humans in the New England area:

• Yellow jackets
• White-faced hornets
• Yellow-faced hornets
• Wasps
• Honey bees

Our division identifies and treats patients who are at risk of suffering life-threatening allergic reactions to these stings. Our goal is to reduce the likelihood of such reactions in subsequent stings.

We typically use allergen skin testing to confirm an allergy to certain insect stings. Where appropriate, we also use blood tests for this same purpose.

All allergists in the Allergy & Clinical Immunology Unit evaluate and treat stinging insect allergies. We adhere to the care guidelines published by the American Academy of Allergy Asthma & Immunology. In appropriate cases, we administer allergy shots—the gold standard for patients at risk of developing systemic (full-body) reactions to stinging insect allergy. For safety, patients should also have self-injected epinephrine on hand at all times.