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Insect bites and stings

Last reviewed: 9 Nov 2024
Last updated: 06 Dec 2024

Summary

Definition

History and exam

Key diagnostic factors

  • witnessed bite/sting
  • local edema
  • local pain
  • local warmth
  • local markings
  • pruritus
  • wheal and flare
  • skin pallor
  • clamminess
  • signs of airway compromise
  • oropharyngeal edema
  • dyspnea
  • rales/crackles/wheeze
  • tachycardia
  • irregular pulse
  • skin flushing
  • altered alertness
Full details

Other diagnostic factors

  • pustules
  • bulls-eye-shaped rash
  • rash on palms and soles
  • linear raised rash
  • hypertension
  • fever
  • muscle cramp
  • diaphoresis
  • tremor
  • paresthesia and/or fasciculations
  • generalized pain
  • nausea/vomiting
  • headache
  • abdominal pain
  • history of immunocompromised state
  • history of cardiovascular disease
  • abscess
  • necrosis
  • cough
  • hypotension
  • arthralgia
  • adenopathy
Full details

Risk factors

  • occupational or recreational exposure to insects
  • geographic exposure to insects
  • previous history of anaphylactic response
Full details

Diagnostic tests

1st tests to order

  • clinical diagnosis
Full details

Tests to consider

  • serum tryptase
  • sensitivity testing
  • CBC
Full details

Treatment algorithm

INITIAL

anaphylaxis

ACUTE

local reaction

ONGOING

secondary infection

Contributors

Authors

David B. K. Golden, MDCM

Associate Professor of Medicine

John Hopkins University

Baltimore

MD

Disclosures

DG has received consultant fees from Novartis, rAquestive, Kokua, and Celldex (all related to anaphylaxis); clinical trial support from Genentech, GSK, Merck, Lilly, Teva, Sanofi, Regeneron, Novartis, AstraZeneca, and Pfizer (all related to nonanaphylaxis disease states); and royalties from UpToDate (related to insect allergy).

Karla E. Adams, MD

Associate Professor of Pediatrics

Uniformed Services University

Department of Medicine, Allergy and Immunology Division, Wilford Hall Ambulatory Surgical Center

San Antonio

TX

Disclosures

KA received an honorarium and paid travel expenses to present lectures at the Eastern Allergy Conference and the Louisiana Society of Allergy, Asthma and Immunology on the topic of insect allergy in 2024.

Acknowledgements

David B.K. Golden and Karla E. Adams would like to gratefully acknowledge Tom Morrissey, a previous contributor to this topic.

Disclosures

Not disclosed.

Peer reviewers

Theodore M. Freeman, MD

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 topic.

Andrew Parfitt, MBBS, FFAEM

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.

Richard DeShazo, MD

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 topic.

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