Feature Article

Allergic reactions to insect bites and stings

Robert J Heddle, Simon GA Brown



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.

Key Points

  • 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.