Insect stings occur commonly, with clinical responses ranging from mild local reactions to life-threatening anaphylaxis. Stings from Hymenoptera (yellow jackets, hornets, wasps, honey bees, and imported fire ants) account for the majority of severe allergic reactions to insects. Patients who present with a systemic reaction should receive emergency therapy and be provided with self-injectable epinephrine (Epi-Pen®) until definitive treatment can be provided. Anaphylactic symptoms and hypotension may be prominent in persons taking beta adrenergic blockers and may necessitate vigorous treatment. The diagnosis of Hymenoptera hypersensitivity can be established by venom skin testing. In more than 95% of cases, immunotherapy with specific venom is effective in preventing subsequent systemic reactions to Hymenoptera stings.
HerbertF.A.SalkieM.L.Sensitivity to Hymenoptera in adult males. Ann Allergy1982; 48, 12–13
4.
ZoraJ.A.SwansonM.C.YungingerJ.W.A study of the prevalence and clinical significance of venom-specific IgE. J Allergy Clin Immunol1988; 81, 77–82
5.
SchwartzH.J.SutheimerC.GauerkeM.G.YungingerJ.W.Hymenoptera venomspecific IgE antibodies in post-mortem sera from victims of sudden, unexpected death. Clin Allergy1988; 18, 461–468
6.
KingT.P.Human antibody response to hornet venom allergen Dol m VB and tobacco leaf protein PR-lb. J Allergy Clin Immunol1989; 83, 231
7.
ParrishH.M.Analysis of 460 fatalities from venomous animals in the United States. Am J Med1963; 245, 129–141
8.
PaullB.R.Imported fire ant allergy. Postgrad Med1984; 76, 155–162
9.
PinnasJ.L.StrunkR.C.WangT.M.ThompsonH.C.Harvester ant sensitivity: in vitro and in vivo studies using whole body extracts and venom. J Allergy Clin Immunol1977; 59, 10–16
10.
GreeneA.BreischN.L.GoldenD.B.K.et al.The sting that stays: autotomy in two common yellowjacket species. J Allergy Clin Immunol1989; 83, 229
11.
TriplettR.F.Sensitivity to the imported fire ant: successful treatment with immunotherapy. South Med J1973; 66, 477–480
RhoadesR.B.SchaferW.L.SchmidW.H.et al.Hypersensitivity to the imported fire ant. J Allergy Clin Immunol1975; 56, 84–93
14.
RhoadesR.B.StaffordC.T.JamesF.K.Bunker-SolerA.ImpsonL.K.Survey of fatal anaphylactic reactions to imported fire ant stings. J Allergy Clin Immunol1988; 81, 202
15.
SmithJ.D.SmithE.B.Multiple fire ant stings. A complication of alcoholism. Arch Dermatol1971; 103, 438
JamesF.K.PenceH.L.DriggersD.P.JacobsR.L.HortonD.E.Imported fire ant hypersensitivity. J Allergy Clin Immunol1976; 58, 110–120
18.
NordvallS.L.JohanssonS.G.O.LedfordD.K.LockeyR.F.Allergens of the imported fire ant. J Allergy Clin Immunol1988; 82, 567–576
19.
MaurielloP.M.BardeS.H.GeorgitisJ.W.ReismanR.E.Natural history of large local reactions from stinging insects. J Allergy Clin Immunol1984; 74, 494–498
20.
BarnardJ.H.Studies of 400 Hymenoptera sting deaths in the United States. J Allergy Clin Immunol1973; 52, 259–264
21.
FreyeH.B.EhrlichB.Acute myocardial infarction following Hymenoptera envenomation. NER Allergy Proc1989; 10, 119–126
22.
MüllerU.StettlerR.HottingerS.Cardiac symptoms (CS) during anaphylaxis to Hymenoptera stings (HA). J Allergy Clin Immunol1989; 83, 230
23.
ToogoodJ.H.Risk of anaphylaxis in patients receiving beta-blocker drugs. (Editorial.). J Allergy Clin Immunol1988; 81, 1–5
24.
LantnerR.ReismanR.E.Clinical and immunologic features and subsequent course of patients with severe insect sting anaphylaxis. J Allergy Clin Immunol1989; 83, 230
25.
LomnitzerR.LannerA.RabsonA.R.Low specific IgE, IgG and lymphocyte reactivity in a group of patients developing anaphylaxis following a honey-bee sting. Clin Allergy1988; 18, 39–44
26.
LivingstonA.ReismanR.E.Late-onset allergic reactions, including serum sickness, following insect stings. J Allergy Clin Immunology1989; 83, 229
27.
EnglerR.J.M.YangE.SalataK.CarpenterG.Recurrent systemic reactions (SR) with bee stings (BST) despite negative (NEG) skin test (SKT) with Hymenoptera venoms. J Allergy Clin Immunol1989; 83, 230
28.
SmithP.L.Kagey-SobotkaA.BleeckerE.R.et al.Physiologic manifestations of human anaphylaxis. J Clin Invest1980; 66, 1972
29.
HuntK.J.ValentineM.D.SobotkaA.K.BentonA.W.AmodioF.J.LichtensteinL.M.A controlled trial of immunotherapy in insect hypersensitivity. N Engl J Med1978; 299, 157–161
GoldenD.B.K.SchwartzH.J.Guidelines for venom immunotherapy. J Allergy Clin Immunol1986; 77, 727
32.
StaffordC.T.RhoadesR.B.Bunker-SolerA.L.ThompsonW.O.ImpsonL.K.Survey of whole body-extract immunotherapy for imported fire ant- and other Hymenoptera-sting allergy. J Allergy Clin Immunol1989; 83, 1107
33.
ReismanR.E.Studies of the natural history of insect sting allergy. NER Allergy Proc1989; 10, 97–101
