Insect venom allergy – causes, symptoms, treatment

Insect venom allergy is a group of clinical symptoms of varying severity, ranging from local to anaphylactic reaction. An allergy occurs after a sting of an allergic person (usually immediately). After a sting, an increased local reaction, acute urticaria, and even fever and angioedema may occur.

Insect venom allergy – characteristics

Insect venom allergy (allergy) is a set of clinical symptoms of varying severity (from local reaction to anaphylactic reaction), which develops after a sting in an allergic person. According to the EAACI (European Academy of Allergology and Clinical Immunology) definition, in the case of allergic background, the term insect venom allergy is used. Most often it occurs as an immediate-type allergic reaction, IgE. dependent (emphasizing the importance of IgE-dependent mechanisms). It may also involve type II, III or IV immune mechanisms. The non-allergic hypersensitivity reaction to insect venoms applies to the remaining types of reactions. Epidemiology is difficult to define, but it is estimated that about 4 percent. of the population is allergic to Hymenoptera venom.

Causes of insect venom allergy

The allergy is most often caused by the venom of hymenoptera insects, which include bees (bumblebee and honey bee) and waspes (common wasp, bumblebee, hornet, Dolichovespula wasp).

Hymenoptera allergens contain several antigens, mainly glycoproteins with a molecular weight of 10 to 50 kDa. The allergenic composition of the venom varies between species. Only one of the antigens, hyaluronidase, cross-reacts between wasp and bee proteins. The venom may also include: biogenic amines, sugars, amino acids, oligopeptides, phospholipids, phospholipases, melittin, apamine, mast cell degranulating factor, kinins, phosphatase, esterase and antigen 5.

People working in a greenhouse or in forestry are the most exposed to allergies. Other people are very rarely allergic to the venom of low aggressive bumblebees. Bee venom allergy usually occurs in beekeepers and their families or people living nearby.

Female bees can sting only once and then die. This is because the bee leaves a sting in the human skin with a sac of venom, muscles and ganglia. The structure of the stinger causes it to sink deeper and deeper into the skin and inject the remainder of the venom. Wasps, on the other hand, do not leave a sting in their skin, so they can attack repeatedly, and the amount of venom is much smaller than in the case of bees. Moreover, it is assumed that the amount of hornet venom is many times greater than that of other Hymenoptera insects.

To get rid of insect venom, including hornets or wasps, try the Tick Remover – TAP OUT, which works like a suction pump. You can find the Sanity product on Medonet Market at an affordable price.

Is everyone allergic to insect venoms?

Not everyone is allergic to insect venoms. Whether or not an allergy occurs depends on whether or not there are antibodies (allergens) in the human body. Specific IgE antibodies directed against various components of the venom take part in the allergic reaction. They are produced by lymphocytes from group B (a group of cells) and then travel with the blood to different parts of the body.

The greatest number of antibodies is found in a variety of tissues, especially the digestive tract, skin, heart, and respiratory system. Therefore, the symptoms of an allergic reaction are related to these systems. Allergic symptoms appear when the right amount of antibody on the surface of cells combines with an appropriate allergen that has entered our body. Then, further changes in the cell are stimulated and active substances called mediators are produced. If the number of mediators is large, they pass into the blood and, along with it, into the entire body. The more mediators released from mast cells, the greater the risk of a violent general (even life-threatening) reaction.

Insect venom allergy – frequency of occurrence

The prevalence of allergy depends on different regions of the world. Bee venom allergy is most common in Central Europe and South Africa. In turn, allergy to wasp venom is most common in the USA and Great Britain. Ant venom allergy occurs in the inhabitants of Central America, Australia and the United States.

Questionnaires are used in epidemiological studies to answer questions about the stings and accompanying symptoms. Additionally, blood tests and skin tests are performed. Only after obtaining the test results, the occurrence of a general reaction is estimated.

How is insect venom allergy manifested?

After a sting, the clinical picture may include: normal local reaction to the sting, increased local reaction, acute urticaria, angioedema, systemic anaphylactic reaction, systemic toxic reaction, unusual reactions (vasculitis, kidney damage, fever, thrombocytopenia).

Most often, after stings, the following are observed:

1. large local reaction (swelling> 10 cm in diameter for> 24 hours; blisters rarely occur); it is not life-threatening if it is limited only to the limbs. If, on the other hand, the sting is in the head, neck, tongue or inside the mouth – it can be life-threatening because the throat or larynx is swollen, so suffocation can result. The general symptoms may be mild to moderate, depending on the organ the stung has;
2. systemic anaphylactic reaction up to shock (-> anaphylactic reaction). The reaction may develop symptoms from the digestive, respiratory and cardiovascular systems.

Muller classification of generalized symptoms in the course of insect venom allergy:

1. First degree – there is hives, anxiety, general weakness and itching of the skin.

2. Second degree – shows at least one of the above-mentioned symptoms or chest tightness, nausea, vomiting, angioedema, abdominal pain, diarrhea, dizziness (at least two symptoms must appear).

3. Third degree – presents any of the above-mentioned symptoms and at least two of the following: speech disorders, wheezing, shortness of breath, weakness, hoarseness.

4. Fourth degree – has any of the above symptoms or at least two of the following: loss of consciousness, low blood pressure, collapse, problems with incontinence and stool, cyanosis.

Symptoms are most severe when they appear early. They usually do not tend to be chronic.

Toxic symptoms

They usually occur in non-allergic people who have been stung repeatedly by many insects. There have been reports of stings by up to several hundred insects at once. These types of stings usually affect very aggressive and irritable insects. The toxic effects of the venom can lead to liver and kidney damage, brain edema, breakdown of muscles responsible for body movement, and breakdown of red blood cells. Therefore, people with a cluster sting should be hospitalized immediately.

Since insect venom allergy can lead to anaphylactic shock, it is advisable to perform an insect venom allergy test. It is available on Medonet Market at an attractive price.

Management of insect stings

In people stung by a bee, the sting should be removed first, preferably within 30 seconds of the sting (it should be lifted). However, it is not allowed to remove the sting by grasping it with two fingers, because this way you can squeeze the remaining dose of venom into the tissues. As mentioned above, after a wasp sting, the sting does not stay in the skin, but it may break, e.g. when we want to quickly knock an insect off our skin. Then a broken piece of the sting may remain in the skin (without the venom sac!).

To safely remove the sting and venom, use the Anti-Tick Venom Removal Tool or the Unstinger Venom Removal Vacuum Pump. You can buy both devices at promotional prices on Medonet Market.

Then an ice pack should be applied to the stung area, because the low temperature causes the vessels to constrict and prevents the venom from entering

The absence of allergy symptoms within a few or several hours from the sting does not require consultation with a doctor. Even in the case of a large local reaction on the limb, oral administration of an antihistamine is sufficient, also without consulting a doctor. However, you should always monitor for the development of further symptoms!

Insect venom allergy – diagnosis

The diagnosis of insect venom allergy requires the following:

1. physical examinations – in the form of a detailed medical interview with the patient about the circumstances and symptoms of the sting. It is important to establish which insect caused the sting. Unfortunately, it is not always possible to accurately determine it, then it is said that the insect is unidentified. It is important for the physician whether the patient was stung for the first time or there were any such incidents in the past (if so, when and by what species of insect). The ever weaker response to subsequent stings suggests that the sensitization is fading away; however, an ever stronger reaction to subsequent stings means that the sensitization is increasing;
2. subjective tests – these are physical tests that are most important in the period of acute symptoms. They allow to determine the severity of allergies and the extent of allergic symptoms (local, general). To assess general symptoms, a complete medical examination is required, which takes into account changes in the skin, changes in the respiratory and circulatory systems, the abdominal cavity, and around the subcutaneous tissue and the central nervous system;
3. additional tests – are carried out in patients with general symptoms and are aimed at identifying people eligible for treatment with the method of specific immunotherapy. This is especially true for patients with symptoms related to the circulatory system, respiratory system and skin symptoms (e.g. urticaria).

In addition, skin tests are performed: prick tests and intradermal tests under surveillance conditions (risk of causing shock), RAST test. The safest diagnostic method is the determination of the level of antigen-specific IgE antibodies in the serum.

Treatment of people allergic to insect venoms

In patients with acute symptoms of insect venom allergy, medications are given in proportion to the severity of symptoms. To begin with, you should limit contact with the allergen, e.g. remove the sting. In addition, a cannula should be inserted into the patient so that large amounts of fluids can be administered intravenously in a short time. If you are allergic, you should receive oxygen during transport to hospital. Preparations administered in acute symptoms include antihistamines, intravenous steroids and bronchodilators in the event of spasm. With symptoms of shock, the patient is given adrenaline. Drug doses should be selected individually for the patient.

People allergic to insect venom should always carry an anti-shock kit containing adrenaline in a pre-filled syringe. Specific immunotherapy is the most effective form of treatment.

Immunotherapy is a very good way to treat anaphylaxis, not just its symptoms. During treatment, an increasing dose of venom allergen extract, to which the patient is allergic, is gradually administered in order to induce a state of tolerance of the immune system. The lower age limit for this treatment method is 5 years, while there is no upper age limit. Before implementing specific immunotherapy, the patient should read the written information about this method of treatment. He should pay particular attention to possible side effects and treatment guidelines. The patient must give his / her consent in writing. Immunotherapy is divided into two stages:

1. initial immunotherapy phase – the dose of the allergen is gradually increased until the maintenance dose is obtained; this stage may take various lengths;
2. second phase – the same dose is given each time (maintenance dose).

How can I prevent stings?

To avoid insect stings, follow these recommendations:

1. avoid eating sweet fruit, ice cream and other sweets while outside,
2. stay in meadows or orchards when there are ripe fruit on the ground,
3. avoid going barefoot as this increases the risk of insect stings,
4. all bins with garbage or food remains should be tightly closed,
5. remember that strong fragrances of perfume and sweat attract insects,
6. when in places where exposure to wasps or bees is increased, you should wear long pants, shirts, a hat and gloves,
7. in case a bee or a wasp stung someone in your surroundings – you should move away at least 50 meters, because other insects may appear,
8. head should be protected / covered in case of possible attack by insects.

The content of the medTvoiLokony website is intended to improve, not replace, the contact between the Website User and their doctor. The website is intended for informational and educational purposes only. Before following the specialist knowledge, in particular medical advice, contained on our Website, you must consult a doctor. The Administrator does not bear any consequences resulting from the use of information contained on the Website.Do you need a medical consultation or an e-prescription? Go to halodoctor.pl, where you will get online help – quickly, safely and without leaving your home.

Lit.:[1] Diwakar L., Noorani S., Huisson A.P., Frew A.J., Krishna M.T.: Practice of venom immunotherapy in the United Kingdom: a national audit and review of literature. Clin Exp Allergy 2008, 38(10); 1651-8. [2] Hafner T., DuBuske L., Kosnik M.: Long-term efficacy of venom immunotherapy. Ann Allergy Ashma Immunol 2008, 100(2); 162-5. [3] Johansson S.G.O., O’B Hourihane J., Bousquet J. i wsp.: A revised nomenclature for allergy. An EAACI position statement from the EAACI nomenclature task force. Allergy 2001, 56; 813-24. [4] Müller U.R., Johansen N., Petersen A.B., Fromberg-Nielsen J., Haeberli G.: Hymenoptera venom allergy: analysis of double positivity to honey bee and Vespula venom by estimation of IgE antibodies to species-specific major allergens Api m1 and Ves v5. Allergy 2009, 64(4); 543-8.

Source: A. Kaszuba, Z. Adamski: “Lexicon of dermatology”; XNUMXst edition, Czelej Publishing House