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Insect bites and stings - Management
Overview of management

  • Most insect bites and stings result in small, local reactions that can be managed symptomatically.
  • Assess the severity of symptoms and assess for infection.
  • Remove any stinger as soon as possible, if present.
  • Treat small local reactions with:
    • Cold compresses, oral analgesics (e.g. paracetamol or ibuprofen), topical crotamiton, topical hydrocortisone, or oral antihistamines.
  • Treat large local reactions with:
    • A short course of an oral antihistamine and oral analgesics.
    • A short course of an oral steroid, if local swelling is severe (e.g. prednisolone 40 mg/day for 3–5 days).
    • If the airway is affected, treat urgently as anaphylaxis.
  • Treat urgently as for anaphylaxis and admit to hospital anyone with:
    • A systemic reaction with respiratory difficulty and/or hypotension.
    • A severe generalized reaction (e.g. vomiting, abdominal or uterine cramps, or wheezing).
    • For detailed information on the treatment of anaphylaxis, see the CKS topic on Angio-oedema and anaphylaxis.
  • If generalized urticaria develops:
    • Give an oral antihistamine and a corticosteroid (e.g. prednisolone 40 mg/day for 3–5 days).
    • If symptoms progress the person should be advised to seek urgent medical help.
  • Admit if mild symptoms progress to a severe reaction (uncommon).
  • Consider referral to an allergy clinic if:
    • Any previous sting or bite has caused generalized symptoms other than at the site of the sting.
  • Seek specialist advice from an allergy clinic or immunologist regarding local recommendations for interim management of anyone waiting to be seen by the allergy clinic.

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