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Tell me about Allergies!

Stinging Insect Allergies

Everyone experiences some pain and swelling when stung by a bee, wasp, hornet or yellow jacket.  But a person who is allergic to such stings often has very large local reaction, or even reactions involving other parts of the body such as hives or difficulty breathing.  Death can occur from blockage of the airway from swelling in the throat.

Diagnosing venom allergy:  Sometimes the history alone makes the diagnosis- if the sting was observed, and the type of insect identified.  If there's question about whether an allergy exists, we'll usually begin with blood testing, looking for a reaction to honey bee, yellow jacket, paper wasp, yellow hornet and white-faced hornet.  If this is negative, yet there is a strong chance that reaction to a sting caused problems, we proceed with skin testing, similar to that done for inhalant (environmental) antigens.

Treating venom allergy:  The first strategy when you have a venom allergy is avoiding areas and situations where an insect sting is more likely. 

The emergency treatment for an insect sting in an allergic patient is auto-injectable epinephrine.  Don't wait to use this.  It's a natural reaction to want to wait and see if things really get serious.  But at the first hint of generalized hives or breathing difficulty after a sting, use the epinephrine (adrenalin) and call 911.

It's best to have 2 doses of epinephrine with you at all times if you are venom allergic (two epipens or one TwinJect).  Epinephrine is fairly short-acting.  If it takes the emergency squad a little time to reach you, your symptoms which improved after the first shot may begin to return.  This would be a sign that the second dose was needed.

Self-injectable epinephrine items can be bulky to carry in a purse, in a pocket, or when participating in a sport.  Here are links to some other options for carrying them:  
          1.  A partial sleeve made of fabric that can be worn on the arm or the leg
          2.  Belt and holsters that attach to belts
          3.  Neoprene leg carrier for wear at the calf or the ankle.

For most people, the best treatment for venom allergy is immunotherapy (shots).  Once the specific insect venom you're allergic to is identified, a customized vaccine is mixed for you.  Starting with a very small dose, the amount in each weekly shot is gradually increased until it is at a known effective dose.  When this is reached, the shots are given once a month for an indefinite period of time, at least 3-5 years.