post-title Stinging Insect Allergy Update: Skin Reactions to Insect Stings 2015-07-31 18:17:42 yes no Posted by

Stinging Insect Allergy Update: Skin Reactions to Insect Stings

By: Dr. Deborah Ortega-Carr There are two types of allergic reactions that occur after an insect sting or bite. Local reactions typically cause itching, burning and swelling that subsides in hours. Systemic reactions cause symptoms distant to the sting site and can be very severe including hives, widespread swelling, shortness of breath,, nausea vomiting, dizziness […]

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By: Dr. Deborah Ortega-Carr

There are two types of allergic reactions that occur after an insect sting or bite. Local reactions typically cause itching, burning and swelling that subsides in hours. Systemic reactions cause symptoms distant to the sting site and can be very severe including hives, widespread swelling, shortness of breath,, nausea vomiting, dizziness and low blood pressure with loss of consciousness. Patients who have had any systemic symptoms are referred to an allergist for further evaluation and treatment. Patients receive skin testing and sometimes blood tests to look for IgE allergy antibodies. Many allergists now measure a tryptase level to assess the risk of anaphylaxis by looking for other risk factors.

Local reactions can sometimes be more significant and are referred to as Large Local Reactions (LRTs) LRT’s are also due to allergy antibodies and are often called late phase inflammatory reactions. The typical large local reaction occurs over several hours, 6 or more hours after the sting, progresses for 24-48 hours and can last 5 days or longer. Although these reactions are associate with low risk of anaphylaxis and venom immunotherapy (shots) are generally not recommended, patients are often very concerned about these local reactions. Ice to the sting site, antihistamines such as Benadryl and a short course of prednisone (or other oral steroid ) can reduce the swelling, redness and itching. These large local reactions can occur to a variety of stinging insects such as Yellow Jackets, wasps, and bees as well as biting insects such as flies, beetles and mosquitos.

Skeeter syndrome is a large local reaction to mosquito bites which is often confused with a skin infection due to scratching. The bite area may appear blistered and swollen. Some children will develop fever and skin reactions may persist for over a week. Mosquito repellent in these patients is necessary to reduce mosquito bites. These reactions may also be treated with topical steroids (immediately after the bite), antihistamines and sometimes oral steroids.

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