Insect Venom
Allergy Facts, Symptoms, and Treatment

While many types of insects and insect-like bugs can cause allergic reactions, the most common varieties are bees, wasps, hornets, yellow jackets, and fire ants.1 Between 56.6 percent and 94.5 percent of the general population report being stung by a Hymenoptera insect (i.e., one that injects venom as a defense mechanism) at least once in their lifetimes.2 That said, it’s common for patients to be uncertain as to which type of insect inflicted the sting, which makes specific IgE blood testing particularly important.3

Typical sting reactions aren’t dangerous and include pain, inflammation, redness, and itching. However, more systemic reactions are possible and can be classified as mild, e.g., urticaria (hives), angioedema (swelling under the skin); moderate, e.g., gastrointestinal symptoms, dizziness, dyspnea (difficult or labored breathing); or severe, e.g., losing consciousness, respiratory or cardiac arrest, anaphylactic shock.2 In fact, up to an estimated 7 percent of the general population has experienced immediate systemic reactions to insect stings, and insect-venom allergy is among the most frequent triggers of severe anaphylaxis in adults.3,4

Where is insect venom found?

The most common insects that cause allergic reactions are bees, wasps, hornets, yellow jackets, and fire ants.1 Bumblebees are increasingly used for pollination in greenhouses, but allergy to their venom is still rare.2 While the ubiquitous honeybee usually leaves its stinger in its victim, where the stinger’s sac continuously pumps venom into the skin until it’s empty or removed, hornets, wasps, yellow jackets, and fire ants can sting repeatedly.3,4,5 Yellow jackets typically nest in the ground and in walls, but wasps and hornets tend to nest on buildings and in bushes and trees. Stinging insects are most active between late spring and early fall.5

Note that the same species of insects may have different names depending on their locales. For example, gallicus dominula, vulgaris germanica rufa, and media saxonica are all known as wasps in Europe, but in the United States, these species are referred to as paper wasps, yellow jackets, and hornets, respectively.3

Fire ants (aka imported fire ants) are native to South America, but they’re also found in Australia, North America, New Zealand, and several Caribbean, Asian, and European countries. The jack jumper ant and green-head ant are the predominant stinging varieties in Australia, where the former causes severe allergic reactions in 2 to 3 percent of sensitized individuals. In East Asia, a particular winged ant (i.e., Pachycondyla chinensis) poses a significant risk of anaphylaxis. While rare, severe reactions including anaphylaxis can also be caused by biting insects such as the Australian tick and kissing bug.7

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Are there other allergens I could be sensitized to?*

The allergens of various honeybee species are similar, and bumblebee venom is comparable to that of honeybees. As such, both are highly cross-reactive.3 Additionally, certain properties of fire ant venom have some cross-reactivity with allergens from yellow jackets, honeybees, and wasps.7

Up to 59 percent of patients with venom allergies test positive for both honeybee and wasp venom. While some of these people have genuine double positivity (i.e., they’re sensitized to both types of venom), others may be experiencing cross-reactivity due to irrelevant cross-reactive carbohydrate determinants (CCD).8 In order to implement an effective management plan, it’s crucial to distinguish between double positivity and clinically irrelevant cross-reactivity.9

Knowing the proteins, or components, within each allergen that may be responsible for your symptoms can help distinguish what type of insect venom is the trigger. With that in mind, and based on your symptom history, your healthcare provider may suggest something called a specific IgE allergen component test to help diagnose your allergies. Results from this test can help your healthcare provider develop a management plan and decide if immunotherapy may reduce your symptoms.3

Already have your specific IgE component test results?

Your component test results will include the name of the components (a series of letters and numbers). Your healthcare provider will likely review the results with you, but here you’ll find an at-a-glance breakdown you can use as a reference. Simply match the component names to the list below to see what they mean in terms of symptom management.3,10,11

Api m 1, Api m 2, Api m 3, Api m 5, Api m 10 (honeybee)

  • Positive to one or several components indicates specific sensitization to honeybee.
  • Patient may be considered for honeybee venom immunotherapy.

Ves v 1, Ves v 5 (common wasp)

  • Positive to one or both components indicates a sensitization to common wasp (yellow-jacket).
  • Patient may be considered for common wasp venom immunotherapy.

Pol d 5 (paper wasp)

  • Indicates a sensitization to paper wasp.
  • Patient may be considered for paper wasp venom immunotherapy.

MUXF3 (CCD)  

  • If MUXF3 CCD (Cross-Reactive Carbohydrate Determinant) is the only positive component test alongside a positive specific IgE test for honeybee, common wasp, or paper wasp, then the cause of symptoms may be something other than stinging insect venom. If CCD is positive in addition to one or more of the aforementioned categories, this may indicate cross-reactive sensitization to the other species.

Tryptase

  • Tryptase is an enzyme that is released, along with histamine and other chemicals, from mast cells when they are activated as part of a normal immune response as well as in allergic responses. A tryptase test may be performed acutely (i.e., minutes to one to two hours after a reaction) and/or as a baseline test.
  • A baseline serum tryptase test is recommended to determine the tryptase concentration in all patients with a history of a severe sting reaction. The importance of identifying these patients has been emphasized, as they may be predisposed to severe anaphylactic reactions and precautionary measures should be considered.

*These products may not be approved for clinical use in your country. Please work with your healthcare provider to understand availability.

How do I manage my allergy?

Your healthcare provider may recommend a plan that includes the following.2,5,12-14

  • Avoid open garbage cans and exposed food at picnics, as they can attract yellow jackets (aka wasps). Keep both sources covered.
  • Avoid wearing sandals or walking barefoot in the grass, as honeybees and bumblebees may forage on white clover often found in grass.
  • Don’t swat at flying insects, which may cause them to sting; rather gently brush them aside or wait for them to leave.
  • Inspect open drinking cups, cans, and straws when outdoors to ensure they don’t contain insects.
  • Avoid sweet-smelling fragrances, hair sprays, colognes, and deodorants, and refrain from wearing bright-colored clothing and floral prints, which can attract bees.
  • Ensure vehicle windows remain closed and your home’s window and door screens are in good condition.
  • Treat fire-ant mounds with insecticide baits.
  • Inform nearby people of any insect stings you incur in case you have a severe reaction and need assistance.
  • Hire a professional to remove any hives or nests near your dwelling.
  • Relocate to a building or enclosed vehicle if you’re stung, as bees release a chemical that attracts other bees.
  • Refrain from using insect repellent, which doesn’t impact stinging insects.
  • Consider venom-specific immunotherapy, which can effectively treat venom allergy in most patients.

Your healthcare provider may direct you to take one of the following medications or actions to improve your allergy symptoms:

  • Remove bee stingers within 20 to 30 seconds after being stung to limit the amount of venom entering your body. Use a scraping, as opposed to pulling motion, to extract the stinger without squeezing more venom into the skin.
  • Ice the area to control swelling, and if stung in the arm or leg, elevate the area.
  • Employ acetaminophen or ibuprofen to help ease pain.
  • Control itching with an antihistamine, ice, hydrocortisone cream, or calamine lotion.
  • Employ topical corticosteroid ointments and oral antihistamines to relieve itching associated with fire-ant stings.

Patients with venom allergy should carry an emergency kit including an adrenaline/epinephrine autoinjector.

If someone you’re with is having an allergic reaction and showing signs of shock, act quickly. Look for a weak, rapid pulse; trouble breathing; cool, clammy, and pale skin; confusion; and loss of consciousness. Immediately do the following:

  • Call local emergency services.
  • Ensure the affected individual is lying down with legs elevated.
  • Administer epinephrine immediately for any obvious signs of anaphylaxis.
  • Check the affected individual's pulse and breathing and administer CPR or other first-aid measures if necessary.

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Insect Venom Allergen Facts, Symptoms, and Treatment

Common Symptoms

Sting-reaction severity varies among individuals, but typical responses include pain, swelling, and redness confined to the sting site.5 Some people, however, will develop excessive local swelling, which can be immediate and peak within an hour or two after the sting or which can develop hours later, increase for two to 48 hours, and resolve after three to 10 days.4 Large local reactions where swelling extends beyond the site are also possible.5

Fire-ant stings can include an itchy localized lump at the sting site, which usually collapses within 30 to 60 minutes. The site then develops a small blister within four hours that eventually fills with dead tissue that resembles pus. However, the blister has a minimal chance of becoming infected unless it’s opened.5

A small percentage of the population has systemic or generalized reactions, which typically include the following mild, moderate, and severe reactions.2,4

Mild reactions usually affect the skin and subcutaneous tissues. They can include:4

  • Generalized erythema (redness)
  • Urticaria (hives)
  • Periorbital edema (puffy eyes)
  • Angioedema (swelling under the skin)

Moderate reactions feature respiratory, gastrointestinal, or cardiovascular involvement and can include:4

  • Dyspnea (difficult or labored breathing)
  • Stridor, wheeze
  • Nausea, vomiting, abdominal pain
  • Chest or throat tightness
  • Dizziness

Severe reactions can include:2,4

  • Cyanosis (inadequate oxygenation, often causing bluish skin discoloration)
  • Hypotension (low blood pressure)
  • Confusion
  • Loss of continence
  • Collapse
  • Anaphylactic shock

Insect-venom allergy can also cause anaphylaxis, which can include symptoms such as:6

  • Constriction of airways and swelling of the tongue or throat, causing wheezing or breathing difficulty
  • Dizziness, fainting
  • Nausea, vomiting, diarrhea
  • Skin reactions including itching, hives, and flushed or pale skin
  • Low blood pressure
  • Weak and rapid pulse

Symptom severity can be amplified by various risk factors and co-factors, such as physical exertion, older age, presence of mast-cell disorders, and male gender.2 Of those adults with mild systemic reactions, roughly 10 percent have a more severe response with subsequent stings. That said, of those with moderate/severe reactions with the initial sting, approximately 45 percent have a less severe reaction with future stings.7 While rare, additional reactions may occur, including serum-sickness-like manifestations, Guillain-Barre syndrome, vasculitis, and more.2

How do I know if I'm allergic?*

Together with your symptom history, specific IgE blood testing can help determine if you are sensitized to a particular allergen. If you are diagnosed with an allergy, your healthcare provider will work with you to create a management plan.

*These products may not be approved for clinical use in your country. Please work with your healthcare provider to understand availability.

Is there a risk for a severe event?

Venom allergy is one of the most frequent triggers of severe anaphylaxis in adults.3 An estimated 1 to 7 percent of the general population exhibits immediate systemic reactions to insect stings.4 Additionally, roughly 20 and 48 percent of severe anaphylaxis cases are caused by insect stings in children and adults, respectively. Anaphylactic death resulting from insect sting typically occurs within 15 to 20 minutes after exposure.2

  1. Asthma and Allergy Foundation of America [Internet]. Arlington, VA: Asthma and Allergy Foundation of America; 2015 Oct. Available from: https://www.aafa.org/insect-allergy.
  2. Blank S, Grosch J, Ollert M, Bilò MB. Precision medicine in hymenoptera venom allergy: Diagnostics, biomarkers, and therapy of different endotypes and phenotypes. Frontiers in Immunology. 2020;11. Available from: https://www.frontiersin.org/articles/10.3389/fimmu.2020.579409/full.
  3. EAACI, et al. Molecular allergology user’s guide. Zurich, Switzerland: European Academy of Allergy and Clinical Immunology; 2016. p. 255-58, 266, 268-69. Available from: http://www.eaaci.org/documents/Molecular_Allergology-web.pdf.
  4. Heddle R. World Allergy Organization [Internet]. Milwaukee, WI: World allergy Organization; 2008 Nov [2015 Aug]. Available from: https://www.worldallergy.org/education-and-programs/education/allergic-disease-resource-center/professionals/allergy-to-insect-stings-and-bites.
  5. American College of Allergy, Asthma & Immunology [Internet]. Arlington Heights, IL: American College of Allergy, Asthma & Immunology; 2018 Feb 5. Available from: https://acaai.org/allergies/types/insect-sting-allergy.
  6. Mayo Clinic Anaphylaxis 2 [Internet]. Rochester, MN: Mayo Foundation for Medical Education and Research; 2019 Sep 14. Available from: https://www.mayoclinic.org/diseases-conditions/anaphylaxis/symptoms-causes/syc-20351468.
  7. Korošec P, Jakob T, Harb H, Heddle R, Karabus S, de Lima Zollner R, Selb J, Thong BY, Zaitoun F, Golden DBK, Levin M. Worldwide perspectives on venom allergy. World Allergy Organ J. 2019 Oct 24;12(10):100067. doi: 10.1016/j.waojou.2019.100067. PMID: 31700565; PMCID: PMC6829763. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6829763/pdf/main.pdf.
  8. Eberlein B, Krischan L, Darsow U, Ollert M, Ring J. Double positivity to bee and wasp venom: improved diagnostic procedure by recombinant allergen-based IgE testing and basophil activation test including data about cross-reactive carbohydrate determinants. J Allergy Clin Immunol. 2012 Jul;130(1):155-61. doi: 10.1016/j.jaci.2012.02.008. Epub 2012 Mar 14. PMID: 22421265. Available from: https://www.jacionline.org/article/S0091-6749(12)00271-0/fulltext.
  9. Kosnik, M., Korosec, P. Importance of basophil activation testing in insect venom allergy. All Asth Clin Immun 5, 11 (2009). Available from: https://aacijournal.biomedcentral.com/track/pdf/10.1186/1710-1492-5-11.pdf.
  10. Blank S, Bilò MB, Ollert M. Component-resolved diagnostics to direct in venom immunotherapy: Important steps towards precision medicine. Clin Exp Allergy. 2018 Apr;48(4):354-364. doi: 10.1111/cea.13090. Epub 2018 Feb 14. PMID: 29331065. Available from: https://onlinelibrary.wiley.com/doi/10.1111/cea.13090.
  11. Labcorp [Internet].  Burlington, NC: Labcorp; 2021. Available from: https://www.labcorp.com/help/patient-test-info/tryptase.(Accessed Nov 2021.)
  12. Mayo Clinic [Internet]. Rochester, MN: Mayo Foundation for Medical Education and Research; 2020 Aug 6. Available from: https://www.mayoclinic.org/diseases-conditions/bee-stings/symptoms-causes/syc-20353869.
  13. InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Insect venom allergies: Short-term and long-term treatment. [Updated 2020 May 7]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK447119.
  14. Mayo Clinic Anaphylaxis 2 [Internet]. Rochester, MN: Mayo Foundation for Medical Education and Research; 2019 Sep 14. Available from: https://www.mayoclinic.org/diseases-conditions/anaphylaxis/diagnosis-treatment/drc-20351474.
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