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Management The three ‘A’s’ of insect allergy:
Avoid, Adrenaline/epinephrine, Allergist
Allergen injection, or desensitisation therapy might work in selected cases
wasp stingA sting from wasps, bees, hornets and yellow jackets, which may trigger allergic reactions varying greatly in severity; avoidance and prompt treatment are essential Management Allergen injection therapy
Pain at the puncture site is almost universally reported. The patient may also develop local swelling, which at times is massive, and localized itch. Generalized hives, dizziness, a tight feeling in the chest, difficulty breathing, swelling of the lips and tongue, stridor, respiratory failure, hypotension, syncope, or cardiac arrest may also occur. Anaphylactic reactions such as these require prompt effective treatment.
If the stinger is still present in the skin, it should be carefully removed. Ice should be applied locally to limit inflammation at the site of the sting and systemic distribution of venom. Diphenhydramine (or other antihistamine) should be given by mouth or parenterally; moreover, if signs and symptoms of anaphylaxis exist, epinephrine should be administered. Corticosteroids are given to reduce the risk of delayed allergic responses. Patients who have had large local reactions or systemic reactions to stings should be referred for desensitization (immunotherapy). In this treatment, gradually increasing dilutions of venom are injected subcutaneously over weeks or months until immunological tolerance develops.
Those with a history of anaphylactic reactions to venom should avoid exposure to the vectors (e.g., ants, bees, snakes, wasps) as much as possible. Protective clothing (e.g., specialized gloves or shoes) may prevent some stings. Cosmetics, perfumes, hair sprays, and bright or white clothing should be avoided to prevent attracting insects. Because foods and odors attract insects, care should be taken when cooking and eating outdoors.
bee stingSee: hymenoptera sting
For mild local reactions, cold compresses and antihistamines are sufficient. Severe reactions may need to be treated with airway management, antivenins, and intensive observation in the hospital. For the source of local antivenins, the use of which is controversial, contact the nearest poison control center.
sea anemone sting
When systemic changes are present, vigorous therapy is indicated for hypotension. Diazepam is administered for convulsions. An electrocardiogram should be monitored for arrhythmias. Treatment for mild stings is symptomatic; application of vinegar to the sting area may inactivate the irritating secretion. All victims should be observed for 6 to 8 hr after initial therapy for rebound phenomenon.
The injury should be treated by washing the wound with copious amounts of water; seawater should be used if sterile water is unavailable. The wound, which is very painful, should be cleansed thoroughly, and all foreign material should be removed. The wound site should be soaked in hot water (113°F or 45°C) for 30 to 60 min to inactivate the venom. Surgical débridement may be necessary, and narcotics may be needed for pain. Tetanus prophylaxis may be required, depending on the patient's immunization status. The wound is either packed open or loosely sutured to provide adequate drainage. Failure to treat this sting may result in gas gangrene or tetanus.