Anyone stung by a bee or wasp is likely to suffer a painful swelling at the site of the sting, and for most people, this isn’t dangerous. But for a small minority, an allergic reaction to an insect sting can be systemic – meaning it affects parts of the body away from the site of the sting. Systemic allergic reactions can be serious and potentially life-threatening (known as anaphylaxis).
The thought of being stung can be very frightening, especially if you know you’re at risk of anaphylaxis. Rest assured though that there are steps you can take to reduce this risk.
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Anyone can become allergic to an insect sting. People who have other allergies, such as hay fever or food allergies, are not at increased risk of having a serious allergic reaction to an insect sting.
You are more at risk of serious allergic reactions to insect stings if you have frequent or multiple stings. Beekeepers and people with a rare condition called mastocytosis are more at risk of having serious sting reactions.
Even if you are allergic to insect stings, you can still enjoy the great outdoors by seeking medical advice, carrying prescribed medication at all times, and taking precautions to avoid being stung.
6 ways to avoid being stung if you have an allergy
Symptoms of a systemic reaction to an insect sting
The symptoms of anaphylaxis due to an insect sting may include:
Swelling in the throat and/or mouth
Feeling faint, dizzy, or very sleepy
Itching and swelling away from the site of the sting
Severe abdominal (stomach) pain
The ABC Symptoms
The term for the most serious form of allergic reaction is anaphylaxis. Most healthcare professionals consider an allergic reaction to be anaphylaxis when it involves difficulty in breathing or affects the heart rhythm or blood pressure. Any one or more of the following symptoms may be present – these are often referred to as the ABC symptoms.
Vocal changes (hoarse voice)
Difficulty in swallowing
Difficult or noisy breathing
Wheezing (like an asthma attack)
Feeling light-headed or faint
Unresponsive/unconscious (due to a drop in blood pressure)
Getting a Diagnosis
If you have previously experienced symptoms away from the site of the sting – such as those listed above – you should see their GP and ask for a referral to an allergy clinic. Your GP can locate an allergy clinic by visiting the website of the British Society for Allergy and Clinical Immunology (BSACI).
People who have large reactions at the site of the sting with swelling of more than 10 centimetres (typically increasing over 24 to 48 hours) will usually have similar reactions if stung again. These people also have a slightly increased risk of a future systemic reaction. Anyone who has suffered a large local reaction like this should see their GP. Most people won’t need to be referred to an allergy clinic, but if you are at increased risk of future stings (if you’re a beekeeper for example), you may benefit from a referral to an allergy specialist.
A small allergic reaction at the site of the sting, however painful, will usually respond to antihistamine medicine and the use of a cold compress.
Anaphylaxis requires an urgent injection of adrenaline. If you are at risk of anaphylaxis, you should be prescribed your own pre-loaded adrenaline auto-injectors (AAIs):
We recommend that you carry two AAIs with you at all times and know how and when to use them.
An AAI should be used as soon as anaphylaxis is suspected.
999 must be dialled immediately after an adrenaline injection is given, as symptoms could return after a short period and more than one injection may be needed.
The emergency service operator must be told the person is suffering from anaphylaxis (pronounced ana-fill-axis).
A second AAI should be given after 5 minutes if symptoms do not improve.
Your GP or allergy specialist may decide you are a suitable candidate for immunotherapy (also known as desensitisation). Immunotherapy is available at a number of specialist centres in the UK, but your need for this treatment must be assessed at an allergy clinic.
The treatment consists of a course of injections of insect venom. It starts at very low doses and rises over an agreed period of time to reach a safe level of venom – usually 100 micrograms. This is the sort of dose you might encounter with multiple stings.
Immunotherapy treatment takes a considerable amount of time and has two phases, known as “initial” (or “up-dosing”) and “maintenance”:
The initial phase lasts for about 12 weeks, during which the very low starting dose is slowly increased to reach the required maintenance levels.
Once this has been achieved, you may be asked to return every month for injections for up to three years. Some centres may have different treatment schedules.
Anyone receiving immunotherapy has to remain in the allergy clinic for a period of time after the treatment in case they suffer an allergic reaction. The risk of a serious reaction is low, and most patients successfully complete the course.
Concerned you may have a wasp or bee sting allergy?
If you’re worried that you may be allergic to the stings of bees and wasps, there are a number of options:
Talk to your GP
Explain to your doctor why you are worried and any symptoms you may have experienced as a result of a wasp or bee sting. They will be able to offer advice and, if appropriate, refer you to an allergy clinic for tests and specialist treatments.
Reducing the chances of wasps and bees bothering you reduces the chances of being stung. Try to avoid the things that attract them such as sugary food and drink, bright clothing and some perfumes found in hairsprays and other cosmetics.
Adrenaline auto-injectors (AAI)
Anyone prescribed adrenaline auto-injectors must carry two AAIs on them at all times.
The NHS offer long-term treatment options that are available from specialist allergy clinics. Speak to your GP to find out more. Should you experience a systemic allergic reaction, the allergy clinic may perform a skin-prick test or a blood test to discover what kind of venom you are allergic to - wasp, bee or both?
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Each wasp species has its own venom so it’s important to find out which of those it is, or whether it’s bee venom that’s the problem. It’s possible to be allergic to both, though most people only react to one.
The insects that cause most systemic allergic reactions in the UK are wasps and honeybees. People aren’t usually allergic to both bees and wasps, although allergy tests can be positive for both. In the UK, systemic reactions are also possible to bumble bee and hornet stings. Elsewhere in the world, other species of bees, wasps, ants and other insects can cause allergic reactions. Allergy tests will help to identify which type of stinging insect you’re allergic to, but they won’t be able to predict the severity of any future reaction.
The bee leaves its stinger (with venom sac attached) in the skin. Because it takes a few minutes for all the venom to be injected, quick removal of the stinger is important. Avoid squeezing the venom sac as this will only inject more venom. The sac should be flicked upwards with one quick scrape of the fingernail or a credit card. This will reduce but not eliminate the risk of a serious reaction.
Beekeepers should take special care. They must always wear protective clothing when collecting swarms or honey. Any beekeeper who is known to be at risk of anaphylaxis to bee venom should seek medical advice on how they may safely continue beekeeping.
Wasps are often aggressive, especially towards the end of the season (late summer and autumn) when they turn to eating decomposing foods.
From autumn until the end of the year, sleepy wasps can still be found perfectly still and not buzzing, so it is much easier to accidentally touch or step on one. Queen wasps hibernate over winter and may choose your bed, curtains, gloves or boots, or tuck themselves into a stack of plant pots in the greenhouse.
A wasp does not leave its sting in the skin – it can sting many times.
Hornets in the UK are larger than a standard wasp. They are brown/orange in colour and often much noisier too, with a loud buzzing sound. Despite their rather threatening size, they are not as aggressive as wasps. When they do sting though, the volume of venom usually makes the stings particularly painful.
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