Up to 5% of people in the United States are affected by stinging insect allergies.  In Florida, the majority of stinging insects are bees, wasps, yellow jackets, hornets and the unforgettable fire ant, which can all pack a big punch.  Typically, wasps build honeycomb nests under eaves and rafters, while hornets construct larger papier-mâché nests that hang in trees and shrubs, and yellow jackets build their hives in the ground, under logs or in walls.  We are well aware Floridians to watch our step outside to avoid fire ants.

What determines whether or not someone might require immunotherapy for a particular stinging insect allergy depends on the intensity of his or her reaction.  A typical local reaction after an insect sting is mild redness, warmth, swelling and pain at the sting site, which most often is transient and disappears on its own within several hours.  Sometimes, people may experience a more extensive local reaction, with swelling extending from the sting site to a large area of the body.

The most dangerous allergic reaction is known as a generalized reaction (anaphylaxis).  This type of life threatening allergic reactions usually occur with 15 minutes of the sting, rapidly progress, and require immediate medical treatment with epinephrine, antihistamines and even corticosteroids.  At times, toxic reaction, not an allergic reaction, may follow as a result of multiple stings.  Because inset venom contains many potent pharmacological agents, vascular collapse, hypotension, shock and even death may occur.

Having a history of generalized allergic reaction to an insect sting, bears a 60% chance of a similar or more serious reaction if stung again.  In these cases, skin testing should be performed to confirm the allergy.  Then, venom immunotherapy (injections of the offending venom to stimulate the immune system and to reduce the severity of future reactions) should be initiated.  Usually completed after three to five years, venom immunotherapy has proven to be 97% successful in preventing future allergic reactions.

Even after patients undergo immunotherapy, it is advised to carry the self-injectable epinephrine (Epi-Pen) because not all patients will maintain a lifelong immunity to insect venom.  If an insect has stung you, immediately scrape the stinger out with a blunt-edged object, such as an index card or credit card, without squeezing it.  Avoid directly pulling the stinger out as this can burst the venom sac and release more venom.  Afterwards, wash the area with soap and water, apply a cold compress or ice pack for 10 to 20 minutes, take Tylenol to ease the pain, and take Benadryl for the itch.

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