Photo: Large Local Reaction to a Wasp Sting



Photo: Wasp Sting Reaction on Flickr http://bit.ly/TEepT. Author: cdresz. All sizes of this photo are available for download under a Creative Commons license.

Large local reactions occur in 17-56% of stung people. Edema may extend to 10 cm from site of the sting. The localized reaction may last 12-24 hours to 7 days.

Large local reactions to stings have a 4-10% chance of a future systemic reaction.

According to more recent studies, large local reactions (LLRs) from stinging insects are followed by a systemic reaction in 10-15% of patients. Prescription of autoinjectable adrenaline is advisable in large LLRs due to insects, immunotherapy studies needed http://bit.ly/HhmUo

Large local reactions can be mistakenly diagnosed as cellulitis.

Local reactions may be life threatening if local swelling at the sting site compromises the airway.

Topical antihistamines should not be used because they may penetrate the wounded skin, bind to proteins and cause sensitization through haptenization.


Mind map of insect venom allergy.

Children generally have a more benign course after insect stings because they usually have only cutaneous systemic reactions. Remember:

C
Children
Cutaneous only

A
Adults
Airway
Anaphylaxis

Selection of patients for SPT and SCIT, from Atlas of allergies and clinical immunology By Philip Fireman:



Hymenoptera venom allergen components from Allergy and Asthma By Massoud Mahmoudi:



Insect allergy from Manual of allergy and immunology By Daniel C. Adelman, Thomas B. Casale, Jonathan Corren:



Related:
Large Skin Reaction to Insect Bites and Stings: Is it Dangerous and What to Do?
Venom immunotherapy reduces large local reactions to insect stings
Anaphylactic Shock Due to Bee Sting
Venom Allergy: A Short Review. V. Dimov, 08/2007.
Beebearding is thought to date back to the 1700s http://goo.gl/j4nE

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