Bee, yellow jacket, wasp, and other Hymenoptera stings: Reaction types and acute management
- Theodore Freeman, MD
Theodore Freeman, MD
- San Antonio Asthma and Allergy Clinic
Hymenoptera species that sting humans include bees, wasps, yellow jackets, hornets, and imported fire ants. Most people develop only minor local reactions, but patients with venom allergy are at risk for systemic allergic reactions (ie, anaphylaxis), which can be particularly severe and are a leading cause of anaphylaxis fatalities. There are also several uncommon and delayed types of reactions that may develop after Hymenoptera stings, such as serum sickness.
This topic reviews the types of reactions that result from Hymenoptera stings, including local reactions and systemic allergic reactions, and the acute management of each. The diagnosis and long-term management of Hymenoptera allergy are presented separately. (See "Diagnosis of Hymenoptera venom allergy" and "Hymenoptera venom immunotherapy: Efficacy, indications, and mechanism of action".)
The insects that are responsible for the majority of serious sting-related reactions belong to the order Hymenoptera. The Hymenoptera families of medical interest include the following [1-3]:
The winged Hymenoptera:
●Apidae family (honey bees (picture 1) and bumble bees).
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- Insect and stinger removal
- LOCAL REACTIONS
- Uncomplicated local reactions
- Large local reactions
- - Treatment
- - Excluding a secondary bacterial infection
- - Future risk of systemic reactions
- - Pathogenesis
- - Prevention
- SYSTEMIC ALLERGIC REACTIONS/ANAPHYLAXIS
- Epidemiology of venom anaphylaxis
- Signs and symptoms
- Diagnosis and laboratory findings
- Acute management
- Discharge care and referral
- Natural history of systemic allergic reactions
- OTHER UNUSUAL REACTIONS
- Toxic reactions from numerous stings
- - Acute treatment
- Other uncommon reactions
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS