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Treating Summer Insect Stings

by Sue Hubbard, M.D.

Staying with the subject of summer ills, I thought it was also appropriate to discuss stinging insects. Stinging insects belong to the order Hymenoptera that includes honeybees, bumble bees, yellow jackets, hornets, wasps and fire ants. I am sure there is a purpose for these insects in the animal kingdom, but they are quite a nuisance in the human kingdom during the summer months. The stinger of the insects delivers their venom to the victim. A honeybee can only sting one time and then dies, while wasps, hornets and yellow jackets may sting multiple times. Bees are actually docile, not very aggressive and typically do not sting, while yellow jackets and hornets are very aggressive (kind of like different types of people). Fire ants, which are so common in the southern and central U.S., also deliver multiple stings by anchoring their little jaws and actually pivoting while they are biting you.

Again, the most common reactions to insect stings are local reactions with pain, redness, and swelling at the sting site. These symptoms usually resolve within several hours and require treatment with the local application of cold compresses, a paste of baking powder or meat tenderizer and analgesia with acetaminophen or ibuprofen. There are also cases of marked local swelling and redness that develops over 12 -24 hours and may be quite large. Again, if this occurs within in the first one to two days following an insect sting, it is unlikely to be due to a bacterial infection. It may take up to five to 10 days to totally resolve and is not dangerous, but may be quite uncomfortable. In some cases a short burst of oral steroids may be required to reduce the inflammation.

A systemic allergic reaction “anaphylaxis” to an insect sting is defined as “causing signs and symptoms in at least two organ systems distant from the site of the sting”. These symptoms may be cutaneous such as generalized, hives, swelling of lips, mouth or tongue and itching, or involve respiratory tract with difficulty breathing, hoarseness and difficulty swallowing. The symptoms may also involve GI tract with vomiting, nausea and abdominal pain, or circulatory system with dizziness, decrease in BP and loss of consciousness. Although children have a lower frequency of anaphylactic reactions to insect stings than adults, the above symptoms are a medical emergency and require immediate intervention.

If your child has ever had a systemic, anaphylactic reaction to an insect sting they should be prescribed an autoinjectable epinephrine device (Twinject/Epipen) and an anaphylaxis treatment plan for its use. Recent evidence also supports prescribing these devices for children who have experienced a generalized acute hive like rash after a sting because of the 10% risk of a more severe reaction from a future sting.

It should be emphasized that multiple doses of epinephrine may be needed (in one study 16 -35%) in treating an anaphylactic reaction after a sting and therefore anyone who has used their own epinephrine should seek immediate medical care as they may require more doses. Children should also have action plans for school, camp etc and should wear a medical identification bracelet.

That’s your daily dose, we’ll chat again tomorrow.

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