What you need to know about
Insect stinging allergy
What is insect stinging allergy?
- Allergic reaction that occurs when immune system overreacts to insect venom, releasing a chemical called histamine that causes allergic symptoms
- Sends more than 500,000 Americans to hospital emergency departments and causes at least 40 known deaths each year
- May affect up to two million Americans at risk of suffering life-threatening reactions
Signs and symptoms
- Itching and/or hives over large areas of body
- Swelling of throat or tongue
- Difficulty breathing
- Coughing/wheezing/shortness of breath
- Dizziness
- Light-headedness
- Stomach cramps, diarrhea
- Nausea or vomiting
- Blood pressure drop, loss of consciousness (severe cases)
Risks
- Other than a previous insect sting, there is no way to identify people at risk for anaphylaxis from insect stings.
- When you experience a large local reaction to an insect sting, it puts you at slightly greater risk for developing a more severe reaction. Studies show that 5-10% of subsequent insect stings cause more serious reactions.
- Unlike insect stings, insect bites rarely cause anaphylaxis. Biting insects such as mosquitoes deposit salivary gland secretions that have no relation to venom allergens and generally cause local reactions.
Causes
It can be very helpful to your allergy specialist if you can describe the type of insect that stung you and where the insect lives. Most allergy sting reactions are caused by five types of insects:
- Yellow jackets
- Black with yellow markings, found in various climates and most common cause of insect stings in mid-Atlantic states
- Live in nests underground or inside building walls, hollow logs, masonry cracks or woodpiles
- Can be disturbed by lawn mowing, gardening or other outdoor activities and are very aggressive, stinging with minimum provocation
- Honeybees
- Round, fuzzy body with dark brown and yellow markings
- Live in honeycombs in trees, old tires or other partially protected sites
- Usually non-aggressive except for those in the Southwest
- Only sting when provoked (often when stepped on with bare feet in grass), leaving stingers behind and dying after
- Paper wasps
- Slender body with black, brown, red and yellow markings
- Live in circular combs under eaves, behind shutters, in pipes on playgrounds, under patio furniture or in shrubs and woodpiles
- More prevalent in early summer
- Hornets
- Black or brown with white, orange or yellow markings
- Live in large gray or brown nests
- Usually found in trees and shrubs and disturbed by activities such as trimming hedges
- Extremely aggressive and can chase people for some distance
- Fire ants
- Reddish brown ants
- Live in large mounds, mostly in warmer southern climates
- May attack with little warning by biting with jaws and inserting highly concentrated toxins that cause immediate burning pain and sterile pustules within 24 hours
Prevention
- Don’t walk barefoot in the yard.
- When gardening, wear slacks, long sleeve shirts, work gloves and shoes.
- Avoid wearing cosmetics, perfumes and hair sprays, which attract insects.
- Avoid wearing brightly colored clothing or flowery prints.
- Be very careful around food and garbage, which especially attracts yellow jackets.
- Keep food covered until eaten.
- If you encounter flying insects, remain calm and quiet, and move slowly. Don’t swat them. If stung, flick the stinger; don’t remove it by pinching with fingers or tweezers.
Treatment
- Emergency medication called epinephrine should be available at all times to treat serious allergic reactions to insect stings.
- Venom immunotherapy (allergy shots) can help prevent serious consequences from being stung and is about 98% protective. We can determine if this treatment is appropriate based on medical history and co-occurring allergies.
What you need to know about
Drug allergies
What are drug allergies?
- Allergic reactions that occur when your immune system overreacts to a drug and releases histamine and other chemicals to attack it
- About 5-10% of adverse reactions to commonly used medications are considered allergic reactions
- Although medications can help counteract this reaction, most have side effects
Signs and symptoms
- Urticaria (hives), usually accompanied by itching
- Angioedema – swelling of body areas with fat tissue
- Hypotension (low blood pressure)
- Bronchospasm, wheezing or cough
- Anaphylaxis – severe, life-threatening reaction involving a combination of symptoms and requiring immediate medical attention, including administration of epinephrine
Types
Antibiotics
Antibiotics are considered the most common cause of allergic reactions in children even though exact incidence rates are unknown due to lack of accurate diagnostic tests. Many people carry the “allergic to antibiotics” label from childhood into adulthood without solid evidence.
- Penicillin
- Only about 10% of patients who report a penicillin allergy are truly allergic.
- Patients with a history of penicillin allergy are frequently treated with broad-spectrum antibiotics, which lead to drug-resistant bacteria.
- Skin testing is useful because results are frequently negative. If negative, an oral antibiotic challenge under an allergist’s supervision is recommended. If positive, penicillin should be avoided, and alternative antibiotics should be used.
- Other antibiotics
- Occurs less frequently in children than adults.
- Skin testing with non-irritating concentrations of antibiotics can help evaluate a possible allergy.
- Your allergist may be able to test for allergies to other medications such as aspirin or NSAIDs (non-steroidal anti-inflammatory drugs).
Aspirin
For some people with asthma, taking aspirin (Bayer, Excedrin, Bufferin) or NSAIDs (Advil, Motrin IB, Aleve) can worsen asthma and nasal and sinus congestion.
- If you have underlying asthma or chronic urticaria (hives), negative reaction to aspirin or NSAIDs may mean cross-reactivity.
- If you DON’T have underlying asthma or chronic urticaria and show an anaphylaxis, angioedema or urticarial reaction, cause is likely medication.
Local anesthetics
- True immediate allergic reactions to local anesthetics are very rare.
- Skin testing followed by graded challenges can help.
Adverse unrelated reactions
- Psychogenic reactions, such as vasovagal response in reaction to injections or sight of blood, can result in anxiety, nausea, lethargy or fainting.
- Coincidental reactions caused by disease being treated for can be mistakenly attributed to drug being used, such as viral rash in children being treated with antibiotics.
Diagnosis
- When taking medication, it’s important to report any prior or current drug reactions.
- Give all of your health care providers a complete list of your medications, including vitamins or other supplements, and note anything that caused a reaction.
- Talk to your allergist/immunologist about medications to avoid and safe alternatives.
Treatment
Mild reactions
- When adverse reaction to medication is mild, treatment with that drug is stopped.
Severe reactions
- More severe reactions usually require antihistamines, steroids or other medications, including epinephrine injections for emergency situations. Antihistamines block effects of histamine, while steroids reduce swelling and inflammation.
- Patients with drug allergies are often given alternative medication.
- If alternative medication isn’t recommended and the drug allergen is essential, treatment may include desensitization therapy. Medication is gradually introduced in small doses until therapeutic dose is achieved. Our allergists offer aspirin allergy desensitization. (Read more about aspirin allergy treatment )
What you need to know about
Latex allergy
What is latex allergy?
- An immune system reaction to natural latex (rubber) found in most latex gloves and many other medical products
- Can pose a serious health risk for some patients and health care workers and may be fatal in rare cases
Latex sources
- Balloons
- Condoms
- Gloves
- Toys
- Rubber bands
- Diaphragms
- Hot water bottles
- Scuba face masks
- Swim caps and goggles
- Rubber plants
- Bottle nipples
- Pacifiers
- Medical products
- Adhesive tape
- Balloon and urinary catheters
- Condom urinary collection devices
- Elastic bandages
- Endotracheal tubing
- Face masks and straps
- Head straps
- Fluid-circulating warming blankets
- Nasopharyngeal or oropharyngeal airways
- Protective sheets
- Elastic bandages
- Blood pressure cuffs
- Dental devices
- Electrode pads
- Enema tubing tips
- Tympanometers
- Hemodialysis equipment
- IV tubing injection ports
- Tourniquets
- Rubber pads
Risk factors
You may be more at risk of having latex allergy if you:
- Wear latex gloves or are exposed to latex through work in health care, with catheters or in latex glove manufacturing
- Have a history of early and/or recurrent surgical or medical procedures
- Have a history of hay fever or other environmental allergies
- Have a history of allergies to tropical fruits, hazelnuts, chestnuts or stone fruits, particularly if progressive in scope or severity
- Wear latex gloves and have hand dermatitis that has changed in severity
- Have had allergic reactions during medical procedures, after contact with balloons or rubber gloves, or after dental or pelvic exams
Prevention and treatment
The best therapy for latex allergy is to recognize the sources of latex contact and avoid them. Learn more through the American Latex Allergy Association.
- All products and medical devices in contact with individuals at risk should be reviewed for possible latex content. A label of “hypoallergenic” does not mean that the product is latex-free.
- Health care workers with known latex allergy must stop using latex gloves and use synthetic latex or non-latex substitutes. These help avoid this condition but may not be equally impermeable to blood-borne pathogens.
- Co-workers should not use powdered latex gloves. Low-allergen, non-powdered latex gloves should be used because powders used in some latex gloves can absorb latex proteins and carry them into the air.
- Bananas, chestnuts and avocado cross-react with latex and may need to be avoided.
