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Bee and Wasp Sting Allergy

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Background

Hypersensitivity to insect stings occurs in up to 5-7.5% of the population and up to one third of bee keepers. Very few of these patients have anaphylaxis and most do not need immunotherapy.

The Honey Bee is the most common cause of allergic reaction to stinging insects. Each bee stings only once. Paper Wasps and European Wasps can sting multiple times, with the Paper Wasp responsible for more serious stings than the European Wasp.

Although stinging insects belong to order of hymenoptera their venoms are very different. Allergy to one type of stinging insect does not usually increase the risk of an allergic reaction to another.

Table 1 below should act as a guide to immediate and long term management of children presenting with hypersensitivity reactions to bee and wasp stings.

Notes

Referral

Immunotherapy should be offered to all patients with anaphylaxis to stings as the standard of care. This includes all patients who have had anaphylaxis (acute gastrointestinal, respiratory, and/or cardiovascular signs/symptoms) from a sting. Referral should be made to the appropriate secondary or tertiary provider where therapy is offered. Treatment initiation and maintenance doses must be done under medical supervision.

The following public paediatric services offer venom immunotherapy initiation (North-to-South):

Table 1: A guide to immediate and long term management of children with hypersensitivity reactions to bee and wasp stings

  Large local reaction Systemic reaction  affecting only skin Systemic reaction with gut,  respiratory or cardiovascular signs and symptoms
Symptoms/signs  - Localised to site  of puncture

- Redness and  induration >10cm in  diameter
 Skin
- Urticaria
- Flushing
- Angioedema
- Itch
Gut
- Abdominal pain
- Vomiting
- Diarrhea

Respiratory
- Voice change/stridor
- Throat tightness
- Cough/dyspnoea
- Wheeze

Cardiovascular
- Pallor
- Dizziness
- Loss of consciousness
- Hypotension
Mechanism  Unsure IgE mediated IgE mediated
Onset Hours Minutes - 2 hours  Can be rapid (minutes) 
Duration to resolution  Days  Hours  Hours 
Immediate treatment  - Remove sting
Oral 2nd generation antihistamines
-
 Possible oral steroid
- Remove sting
- Oral 2nd generation  antihistamines 
- Remove sting
- Adrenaline - IM (0.01ml/kg
of 1:1000)
- Oral 2nd generation
antihistamines
- Possible oral steroid 
Risk of systemic
reaction with
subsequent sting
 Low risk of severe anaphylaxis - 9% risk of similar reaction
- Very low risk of more
severe (anaphylaxis) 
30-60% risk of anaphylaxis
ASCIA Action Plan  Yes Yes Yes
EpipenĀ®  No  Yes  Yes 
Testing indicated
- Venom sIgE
- Tryptase
 
No
No
 
No*
No*
 
Yes
Yes
VIT indicated No  No*  Yes

IgE, immunoglobulin E; sIgE, specific IgE (tested either on serum or skin prick testing); IM, intramuscular; VIT, venom immunotherapy; ASCIA, Australasian Society of Allergy and Clinical Immunology (www.allergy.org.au).

* May be considered in rare cases where high risk of re-sting and other risk factors for severe reaction

Document last reviewed: April 2017

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