Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • witnessed bite/sting
  • local oedema
  • local pain
  • local warmth
  • local markings
  • pruritus
  • wheal and flare
  • signs of airway compromise
  • oropharyngeal oedema
  • dyspnoea
  • rales/crackles/wheeze
  • tachycardia
  • irregular pulse
  • skin flushing
  • skin pallor
  • clamminess
  • altered alertness

Other diagnostic factors

  • pustules
  • bullseye-shaped rash
  • rash on palms and soles
  • linear raised rash
  • hypertension
  • fever
  • muscle cramp
  • diaphoresis
  • tremor
  • paraesthesia and/or fasciculations
  • generalised pain
  • nausea/vomiting
  • headache
  • abdominal pain
  • hx of immunocompromised state
  • hx of cardiovascular disease
  • abscess
  • necrosis
  • cough
  • hypotension
  • arthralgia
  • adenopathy

Risk factors

  • occupational or recreational exposure to insects
  • geographical exposure to insects
  • previous history of anaphylactic (or anaphylactoid) response

Diagnostic investigations

Investigations to consider

  • FBC
  • tryptase
  • sensitivity testing
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Tom Morrissey

Associate Professor

Department of Emergency Medicine

University of Florida

Jacksonville

FL

Disclosures

TM declares that he has no competing interests.

Tom Morrissey would like to gratefully acknowledge the assistance of Richard Vetter (MS) from the Department of Urban Entomology at the University of California. Not disclosed.

Peer reviewers VIEW ALL

Allergist and Immunologist

Jacobs Ramirez and Freeman Allergy & Immunology

San Antonio

TX

Disclosures

TMF is an author of a number of references cited in this monograph. He also contributed several pictures at the request of the author.

Clinical Director

Acute Medicine

Associate Medical Director

Consultant Emergency Medicine

Guy's and St Thomas' NHS Foundation Trust

Clinical Lead and Consultant

Accident Emergency Medicine

St Thomas' Hospital

London

UK

Disclosures

AP declares that he has no competing interests.

Chairman and Professor

Department of Medicine

Professor of Pediatrics

Billy S. Guyton Distinguished Professor

University of Mississippi Medical Center

Jackson

MS

Disclosures

RD is an author of a reference cited in this monograph.

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