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Venom Allergy Patient Management
Management of a venom allergy begins with an understanding of the patient’s sensitivities, which can be gleaned through a detailed history of sting reactions or skin testing. From there, management takes on a two-prong approach: acute treatment of reactions and long-term management.1
Immediate management is centered around avoiding the insects most likely to cause a reaction. These could include:1
- Honeybees
- Yellow Jackets
- Wasps
- Hornets
- Fire Ants
Following diagnosis, well-established clinical guidelines for management of venom allergy will better facilitate patient management:
A long-term approach to managing venom allergies may involve a combination of avoidance of high-risk activities and locations where the insects could be present, use antihistamines or injectable epinephrine, or targeted venom immunotherapy (VIT).1 If a patient is diagnosed and has had a severe reaction, VIT is the only current treatment available and is strongly recommended.
Patient Education
Allergy to insect venom has been reported to cause emotional distress in patients leading to a decrease in their quality of life,2 so communicating the most effective management strategy can help alleviate the fear associated with another potential reaction.
Patients must be informed of proper avoidance measures to reduce the likelihood of a sting and subsequent reaction, including:3
Having known or suspected nests in the immediate vicinity of the patient’s home removed by trained professionals, in addition to periodic inspections
Avoidance of improper attire that may attract insects- brightly colored clothing, open shoes, flowery prints, or strongly scented perfume.
Keeping insecticides approved for use on stinging insects on hand to kill stinging insects from a distance if necessary. (stinging insects are not affected by insect repellants, and fire ants require different specific insecticides)
Avoidance of eating or drinking food or beverages that attract insects outdoors when possible
Due to the potential severity of a venom reaction, patient education for this allergy is often best articulated by an allergist-immunologist who is exceptionally familiar with hypersensitive reactions to insect stings. Referral to a specialist is recommended when patients have previously experienced a systemic reaction from an insect sting, especially those who:4
- Need further education about their risk of another reaction if they are stung
- Need to be made aware of options for emergency and prevention treatment
- Have a coexisting condition or are currently on medication that might complicate a potential reaction to a sting request
- Need consultation for more detailed information or specific testing
Reducing the Risk for Anaphylaxis Due to Insect Venom
Because of the potential for anaphylactic shock that accompanies venom allergy1, those who have a history of systemic reactions should be well informed about emergency management and supplied with an anaphylaxis action plan. Adrenaline should always be considered the first line of emergency treatment in those experiencing an anaphylactic reaction.
Data shows that 20% of documented anaphylaxis is due to venom reactions, and fatalities due to insect stings range from 0,03 to 0,48 per million inhabitants yearly.1
In patients with a low risk for an anaphylactic reaction, the need to carry epinephrine can be decided on a case-by-case basis and can take into account the patient’s history and level of anxiety associated with the allergy.5
Follow Up and Reevaluation
Approximately 30% to 60% of patients with a history of systemic allergic reactions from an insect sting will experience a systemic reaction when restung.4 Because of their high risk for a life-threatening reaction, it is important to determine a patient’s individual sensitizations. This can give you the information needed to best understand a patient’s risk for subsequent reactions and to develop the most appropriate treatment and follow up plan.
For patients with a history of systemic reactions to insect venom, you may consider advising them to:4
- Carry epinephrine for emergency self-treatment and be familiar with proper use and indications
- Obtain and carry a medical identification bracelet or necklace
- Undergo component resolved IgE testing for stinging insect sensitivity5
- Receive immunotherapy (testing is optional for patients in whom VIT is not required)
Determine your patient’s individual sensitizations to optimize management.
Tests
Diagnostic tests give reliable results that support primary care physicians as well as specialists in providing optimal patient management.
Ludman SW, Boyle RJ. Stinging insect allergy: current perspectives on venom immunotherapy. J Asthma Allergy. 2015;8:75-86.
Oude Elberink JN, de Monchy JG, Golden DB, et al. Development and validation of a health-related quality-of-life questionnaire in patients with yellow jacket allergy. J Allergy Clin Immunol. 2002;109(1):162-170.
American College of Allergy, Ashtma, & Immunology. http://acaai.org/allergies/types/insect-sting-allergies. Accessed December 2017.
Golden DBK, Molffitt J, Nicklas RA. Stinging insect hypersensitivity: A practice parameter update. 2011. J Allergy Clin Immunol. 2011;127(4):852-854.e23
Sturm GJ, Varga E-M, Roberts G, et al. EAACI guidelines on allergen immunotherapy: Hymenoptera venom allergy. Allergy. 2017;00:1–20. https://doi.org/10.1111/all.13262
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