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Allergists Update Stinging Insect Guidelines

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Summer brings bees, wasps, hornets, and yellow jackets, and this year, updated advice for those who are allergic to these pesky stinging insects. The American College of Allergy, Asthma and Immunology recently published updated guidelines for diagnosing and treating stinging insect hypersensitivity. Here are three key highlights for those who are allergic.

Give immunotherapy a shot.
A growing body of research indicates that immunotherapy (also called allergy shots) is 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 people who are terrified of being stung. While an epinephrine injection 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.

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

Watch out for risk factors.
Some people are at increased risk for serious reactions. High-risk people include those who have a history of severe or near-fatal reaction to a stinging insect; have heart disease, high blood pressure, or pulmonary disease; have had a reaction beyond the site of a sting; have asthma; take beta blocker or ACE inhibitor medications; or have frequent unavoidable exposure, including beekeepers and gardeners.

“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,” says Richard Nicklas, MD, 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 include not only skin symptoms, but also tightness in the chest and difficulty breathing; swelling of the tongue, throat, nose, and lips; and 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. Allergists can also determine if you are a candidate for venom immunotherapy.


Source: American College of Allergy, Asthma & Immunology,

This article was originally published in Coping® with Allergies & Asthma magazine, Spring/Summer 2011.