ACAAI issues updated guidelines for treating stinging insect hypersensitivity

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Spring and summer bring bees, wasps, hornets and yellow jackets and, this year, updated advice for those who are allergic to these pesky stinging insects. More than half a million people go to emergency rooms and at least 50 die each year from insect stings.

The American College of Allergy, Asthma and Immunology (ACAAI) and its allergist members - doctors who are experts on allergies and asthma - recently published updated guidelines for diagnosing and treating stinging insect hypersensitivity. Here are three key highlights for those who are allergic:

1. Give Immunotherapy a Shot. A growing body of research indicates that immunotherapy (also called allergy shots) is very effective in preventing reactions. The treatment works like a vaccine, exposing you to increasing amounts of the stinging insect allergen to build your immune system's tolerance to it. By eliminating the allergic reaction, the treatment also can improve the quality of life for patients who are terrified of being stung. While an epinephrine injection can prevent death and is the most immediate way to treat an allergic reaction at the time of a sting, venom immunotherapy is the only way to actually prevent the reaction from starting.

2. Beware the Flight of the Bumblebee. Although typically considered less aggressive, bumblebees are increasingly causing severe allergic reactions, particularly in greenhouse workers, and should be avoided as much as other stinging insects.

3. Watch Out for Risk Factors. Some patients are at increased risk for serious reactions and should make sure they see an allergist. High-risk patients include those who have:

  • a history of severe or near-fatal reaction to a stinging insect
  • heart disease, high blood pressure or pulmonary disease who have had a reaction beyond the site of a sting
  • asthma
  • to take beta blocker or ACE inhibitor medications
  • frequent unavoidable exposure, including beekeepers, gardeners, etc.

"For most people, an insect sting means nothing more than a little pain, swelling and redness. This is a normal reaction and can be treated at home," said Richard Nicklas, M.D., ACAAI spokesperson and one of the authors of the updated guidelines. "An allergic reaction is more severe and often includes hives, itching and swelling in areas other than the sting site. These reactions require immediate medical attention."

Symptoms of a severe allergic reaction, also called anaphylaxis, might not only experience skin symptoms, but any of the following:
• Tightness in the chest and difficulty breathing
• Swelling of the tongue, throat, nose and lips
• Dizziness and fainting or loss of consciousness, which can lead to shock and heart failure

These symptoms require immediate attention at the nearest emergency room where epinephrine will be administered.

The ACAAI recommends anyone who has an allergic reaction to an insect sting see an allergist to determine the best course of treatment, An allergist can prescribe an epinephrine kit and teach you and your family members how to administer an injection to treat severe reactions and can determine if you are a candidate for venom immunotherapy.

The ACAAI also suggests you can reduce the chance of summer insect stings by following these tips:
• Keep food covered when eating outdoors.
• Don't drink beverages outdoors from cans or straws. Stinging insects are attracted to the sweetness and may crawl inside the can or straw.
• Cover garbage cans stored outside with tight-fitting lids.
• Avoid areas where stinging insects are swarming


The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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