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Hymenoptera (Bee Sting) Allergy
Diagnosis/Definition:
Systemic reaction to insect sting causing anaphylactic reaction.
Initial Diagnosis and Management
- Determine whether it was a systemic or local reaction to insect sting.
- If systemic, treatment with epinephrine and secondarily with Benadryl and/or supportive care as necessary based on severity of the reaction. Corticosteroids can prevent the delayed reaction.
Ongoing Management and Objectives
- There is no data that patients with large local reactions even if encompassing entire limb have an increased risk of anaphylaxis. They do not require epinephrine kit or referral.
- Children (age < 16) who have experienced only cutaneous angioedema or urticaria have a very low risk of repeat anaphylaxis and current recommendation is that they do not require epinephrine kit or referral. Adults (16 and older) who experience the same reactions should receive the Epi-pen and referral to Allergy.
- All individuals who have experienced anaphylaxis (other than as above cutaneous symptoms only in children) should have an Epi-pen in their possession. Each individual given an epinephrine kit should be given competent instruction on both when and how to use it.
- Medical records should be appropriately annotated with the information on the known allergies and medical warning jewelry or written documentation should be carried on the person.
Indications for Specialty Care Referral
All patients who have had systemic reactions to bees, wasps, hornets, yellow jackets or fire ants should be sent to the Allergy clinic for consideration of immunotherapy. Immunotherapy has been shown to be very effective decreasing the risk of anaphylactic reaction from around 50% to about 2-5%. Only exception is children with only cutaneous symptoms.
No testing is available for systemic reactions to insects other than bees, wasps, hornets, yellow jackets or fire ants, so referral is not indicated for allergic reactions to insects other than bees.
Large local reactions to hymenoptera stings without any history for anaphylaxis should not be referred.
All active duty (who have a history of anaphylactic reactions to hymenoptera) are REQUIRED to be on immunotherapy to remain on active duty. They MUST be sent for referral.
Skin testing can not be reliably done until around 3-4 weeks after the systemic reaction so urgent referral is not indicated.
Criteria for Return to Primary Care
Documentation that reaction was not allergic, or patient is no longer allergic.
Completion of immunotherapy. Immunotherapy usually lasts 4-5 years.
