Although sensitisation to insect stings is common, serious life threatening reactions are not. Initial treatment of patients with allergies to insect stings may involve intramuscular adrenaline, oxygen and intravenous fluids; ongoing management depends on an assessment of risk of future reactions for each individual.
- Sensitisation to local stinging insects is extremely common, immediate systemic allergic reactions are less common, and deaths following insect stings are very uncommon.
- Adrenaline, oxygen and intravenous fluids are the main therapies likely to be effective acutely for a systemic allergic reaction.
- Beware delayed and progressive reactions – a period of observation is essential.
- The prognosis of patients with purely cutaneous reactions to insect stings is usually favourable, but deteriorates progressively in those with a history of anaphylaxis of increasing severity.
- The automated adrenaline syringe is a major asset to first aid in the community and has wide acceptance; provision of a written action plan is also important.
- Patients with a history of immediate systemic allergic reactions with respiratory or hypotensive features should be referred to a clinical immunologist or allergist for advice regarding venom immunotherapy.