Most people have local redness, swelling, feeling hot to touch, and some itching and pain when they are stung by insects. However, there are a few that are allergic and when they are stung, they experience more symptoms including: hives, 
flushing, swelling of the face, eyelids, mouth, hands, and feet. Others may have a more serious allergic reaction called anaphylaxis, and it includes difficulty breathing/wheezing, swelling of lips, tongue, and throat, nausea, vomiting, abdominal cramps, diarrhea, and fainting/feeling dizzy as the result of a drop in blood pressure which could lead to shock. If you ever experience anaphylaxis, call 9-1-1 as this is a medical emergency.
These people, after being stung, produce antibodies called immunoglobulin E (IgE), and with subsequent encounters with same the insect, the venom interacts with the IgE antibody, triggering the release of substances that cause an allergic reaction. One of these substances is called “histamine”.
The usual insects responsible for allergic reactions are:
Honeybees: non-aggressive and they attack when they are provoked, but Africanized honeybees (Killer Bees) found in the southwestern US are more aggressive. Domesticated honeybees live in man-made hives. The wild ones live in colonies (honeycombs) in hollow trees or cavities in buildings.
Yellow jackets: have yellow and black stripes, their nests are usually under the ground, but sometimes, can be found in farm buildings, masonry cracks and woodpiles.
Paper wasps: usually they have brown and yellow stripes and are a bit larger than yellow jackets. Their nests are usually made of a paper-like material, often located under the eaves, behind shutters, woodpiles, and sometimes in pipes.
Hornets: usually larger than yellow jackets, their nests are also made with a paper-like material close to that of yellow jackets and wasps, above the ground in tree hollows, tree branches and shrubs.
Fire ants: build nests from dirt in the ground, usually visible above the ground sometimes as high as 18 inches.
Many times, the flying insects are confused for one another.
Preventing stings:
Avoid these insect’s nests. If their nests are disturbed, they are very likely to sting you. Have their nests, in your living area, professionally destroyed.
If you find a flying insect close to you, avoid sudden movements and try to get away calmly and slowly. Foods attract some insects. Do not leave uncovered food outdoors before you eat them (watch out for open soda cans also). When outside, avoid bright clothing and perfumes. Avoid open-toe shoes and loose-fitting clothes, as insects can become trapped in them. If they are in your home, please call a pest-control service to get rid of the nest safely. Avoid stepping on fire ant mounds.
Treatment:
For a local reaction, apply cold compresses and raise the affected limb to reduce swelling. Gently clean the area with soap and water/rubbing alcohol. If the stinger is left on your skin, do not try to grab it and pull it out. That could squeeze more venom into your skin. A quick scrape with a knife or your finger nail can remove it. You may use a topical steroid cream or ointment at the site to reduce itching. You may also take oral Benadryl to help with the itching and swelling. Please be careful, especially with young children, that they are not scratching it and causing an infection of the area. For this, we also recommend applying mupirocin ointment or another topical antibiotic ointment. If you suspect that the site is getting infected and not improving with creams, please see your physician.
If you are severely allergic to insects:
You should always carry an Epinephrine auto-injector device. Please learn when and how to use it. Check its expiration date every couple of months since it does not have a long shelf life. Please do not leave it in your car or other hot/cold areas as it de-activates the medication. Remember epinephrine is a rescue treatment. After using it, you must still have someone take you to the closest emergency room or dial 9-1-1.
Skeeter syndrome:
This is an allergic reaction that can occur to mosquito bites, due to the protein in their saliva. Beyond the typical whelp like lesion that can occur with mosquito bites, someone with skeeter syndrome can have a large area of redness, swelling (even the whole limb can be affected), itching, and pain and this may last for weeks. In severe cases, some people can develop small blisters or dark spots. These large uncomfortable reactions typically happen right away and can sometimes be confused with an infected bite, which takes several days to occur. Beyond the previously mentioned avoidance measures, those who have skeeter syndrome should apply bug spray (containing DEET) prior to going out in areas where there are mosquitos and avoiding dusk and dawn (times when mosquitos are most active). The treatment options are the same as discussed above, in addition to taking over the counter pain relievers such as ibuprofen (at age-appropriate dosing).
Consult an Allergist
If you are highly allergic to insects and have had anaphylaxis in the past or have recurrent exposure to insects, consulting an allergist is strongly recommended. Many people have no idea what insect they were stung by or have the wrong impression about the culprit insect. With proper testing, your allergist can diagnose an insect allergy properly and discuss the potential of allergy shots to help you become less likely to have a serious reaction should you get stung again. Allergy shots will be given in the clinic for at least 3 years usually to help you be more confident and enjoy being outdoors without fear of a future severe allergic reaction.
At NTAAC, all of our allergists are board certified, and we can help!
Hana M. Tartibi, M.D.
Board Certified Allergist
