Allergic reactions to flying stinging insects – honeybees, hornets, wasps and yellow jackets – are relatively common. In the southern United States, the red or black imported fire ant now infests more than 260 million acres where it has become a significant health hazard and may be the number one agent of insect stings there. The severity of an insect sting reaction varies from person to person. A normal reaction will result in pain, swelling and redness confined to the sting site. A large local reaction occurs in 10-15% and will result in swelling that extends beyond the sting site. For example, a sting on the forearm could result in the entire arm swelling twice its normal size. Although alarming in appearance, this condition is not dangerous and is often treated the same as a normal reaction. The rarest but most severe sting reaction, called anaphylaxis, occurs in about 0.5% of children and 3% of adults who are stung. At least 90 to 100 deaths per year result from insect sting anaphylaxis.

If you are referred to MLA for evaluation of an insect sting, a careful history will be obtained. Based on this, allergy testing may be performed likely with a skin test, but sometimes through a blood test. As the skin testing for a stinging insect reaction is involved, this will be performed at a separate visit. Based on your history and the results of the testing your physician will be able to recommend the best intervention for you. For those experiencing a severe sting reaction this may include allergy immunotherapy – “desensitization” (see below) as well as self-injectable epinephrine (EpiPen) and MedicAlert® identification.

Avoiding Insect Stings

Knowing how to avoid stings from fire ants, honeybees, wasps, hornets and yellow jackets leads to a more enjoyable summer for everyone. Stinging insects are most active during the late spring, summer, and early fall. Insect repellents do not work against stinging insects. Yellow jackets will nest in the ground and in walls. Hornets and wasps will nest in bushes, trees and on buildings. Use extreme caution when working or playing in these areas. Avoid open garbage cans and exposed food at picnics, which attract yellow jackets. Also, try to reduce the amount of exposed skin when outdoors.

Consider the following additional precautions to avoid insect stings:

• Avoid wearing sandals or walking barefoot in the grass. Honeybees and bumblebees forage on white clover, a weed that grows in lawns throughout the country.
• Never swat at a flying insect. If need be, gently brush it aside or patiently wait for it to leave.
• Do not drink from open beverage cans. Stinging insects will crawl inside a can attracted by the sweet beverage.
• When eating outdoors, try to keep food covered at all times.
• Garbage cans stored outside should be covered with tight-fitting lids.
• Avoid sweet-smelling perfumes, hair sprays, colognes and deodorants.
• Avoid wearing bright-colored clothing.
• Yard work and gardening should be done with caution. Wearing shoes and socks and using work gloves will prevent stings on hands and feet.
• Keep window and door screens in good repair. Drive with car windows closed.

Venom Immunotherapy

The long-term treatment of insect sting allergy is called venom immunotherapy. It is a highly effective program administered by an allergist, which can prevent future allergic reactions to insect stings.

Venom immunotherapy involves administering gradually increasing doses of venom to decrease a patient’s sensitivity to the venom. This can reduce the risk of a future allergic reaction to that of the general population. In a matter of weeks to months, people who previously lived under the constant threat of severe reactions to insect stings can return to leading normal lives.