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
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
Risk factors
- occupational or recreational exposure to insects
- geographic exposure to insects
- previous history of anaphylactic (or anaphylactoid) response
Diagnostic tests
1st tests to order
- clinical diagnosis
Tests to consider
- CBC
- serum tryptase
- sensitivity testing
Treatment algorithm
anaphylaxis/anaphylactoid reaction
local reaction
secondary infection: immunocompetent; low MRSA risk
Contributors
Authors
Tom Morrissey, MD, PhD
Associate Professor
Department of Emergency Medicine
University of Florida
Jacksonville
FL
Disclosures
TM declares that he has no competing interests.
Acknowledgements
Tom Morrissey would like to gratefully acknowledge the assistance of Richard Vetter (MS) from the Department of Urban Entomology at the University of California.
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.
Differentials
- Cellulitis
- Periorbital and orbital cellulitis
- Abscess
More DifferentialsGuidelines
- Anaphylaxis - a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis
- Anaphylaxis - a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis
More GuidelinesPatient information
Insect bites and stings
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