Stinging Insects

by Christopher C. Chang, M.D.

In the summertime, our region is abundant with stinging insects including apis (e.g. honeybees), vespids (e.g. yellow jackets, wasps and hornets) and formicids (e.g. fire ants). Stings from all of these species can cause a variety of reactions, ranging from local reactions such as pain, swelling and redness at the site of the sting, to full-blown anaphylaxis–life-threatening swelling of tissue in the mouth and throat that can block airways.

For the majority of kids and adults,  a bee or wasp sting is just a nuisance. But for others, a more serious reaction can occur due to the toxin in the venom or an allergic reaction to the sting. Here’s how to avoid stings – and how to react if a child (or adult) with you has a troubling reaction.

Symptoms: Tightness or swelling of the throat, lips or tongue or difficulty breathing could be signs of anaphylaxis and require emergency treatment. It is advisable to seek medical attention for a sting anywhere in the mouth or neck because stings in oral mucous membranes can quickly cause severe swelling that may block airways, and people can die from anaphylaxis. Adults and children 16 years of age or older who develop hives widely spread throughout the body should also seek urgent medical attention.

Checking in advance for allergic reactions: For children under16 years with a known systemic reaction to an insect sting, an allergy specialist can skin test them for sensitivity to venom. If the reaction only involves the skin at the site of the sting and no other part of the body, testing is usually not recommended. Children may be allergic to one species or several. All children with an anaphylactic reaction to insect stings should carry an epi-pen at all times. However, for these children, allergy shots (venom immunotherapy) arethe treatment of choice, because allergy shots have been shown to decrease the chance of death.

Preventing stings – and allergic reactions: To help prevent stings, avoid using strong perfume, hair spray, deodorants or lotions as insects are attracted to fragrances. Avoid walking barefoot where stinging insects may be present. When outdoors, cover food, drinks and garbage that attract insects and use insect repellant. If your child does have an allergy to insect stings, your doctor can provide an action plan that includes epinephrine (epi-pen)and how and when it should be used. Make sure anyone looking after the child understands the action plan and how to give epinephrine and or any other medication prescribedfor the treatment of reactions. Always carry an emergency pack with an oral antihistamine like Benedryl and an epi-pen and consider having the child wear a medic-alert bracelet or necklace.

Christopher C. Chang, M.D., Ph.D., is division chief of the division of pediatric allergy/immunology at Nemours/Alfred I. duPont Hospital for Children, and clinical professor of pediatrics at Jefferson Medical College.

Is your child allergic to insect bites or stings? How do you keep him or her safe?