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Insect bites and stings - Management
When should I refer or seek specialist advice?

  • Admit all patients with anaphylaxis, after immediate emergency management.
  • If mild symptoms appear to be worsening, admission may be required for observation (uncommon).
    • The decision to admit will depend upon on the type of reaction, social circumstances, and access to local medical facilities. Exercise clinical judgement in these circumstances.
  • Consider referral to an allergy clinic if an insect sting or bite has caused generalized symptoms.
  • The Anaphylaxis Campaign recommends referral to an allergy clinic if there is a large local skin reaction, with redness and swelling over 10 cm in diameter. However clinicians should check the referral policy of their local allergy clinic as this may vary.
  • 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.
Clarification / Additional information
  • Treatments that may be offered by an allergy clinic include:
    • Self-injectable adrenaline. This is usually prescribed to people at known risk of systemic reactions to bee or wasp venom, together with a written treatment plan. The patient (and relatives) are usually taught in secondary care how and when to use the adrenaline self-injector.
    • Immunotherapy (desensitization). This is available at a few centres in the UK.
      • The diagnosis of wasp or bee sting allergy can be confirmed at an allergy clinic. Any potential risk can then be discussed [The Anaphylaxis Campaign, 2005].
      • Immunotherapy consists of a weekly injection for 8 weeks. If by that time a dose of two stings has been reached, then monthly injections are continued for two to three years or longer. Some specialised clinics use various modifications of this injection treatment.
      • The indications for desensitization in Britain are conservative, because of the high incidence of spontaneous improvement, and the potential adverse effects of desensitization treatment [Ewan, 1998].
      • Immunotherapy continues to be available at specialized centres because it is effective in cases of life-threatening venom hypersensitivity.
      • All patients receiving immunotherapy have to wait one hour after each injection in case it causes a reaction.
Basis for recommendation

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