Insect stings frequently cause large local responses (LLRs) that cause morbidity. These responses do have an immunologic foundation; nevertheless, as detailed in this study, individuals who come with LLRs should be treated differently from those who arrive with systemic allergic reactions. Morbidity is caused by both the inflammation and the iatrogenic effects of therapy. Antihistamine medicines and antibiotics are typically not recommended for individuals with LLRs due to the risks/side effects of these drugs and the poor likelihood of effectiveness. Some individuals are also afraid that a subsequent sting would develop into a potentially fatal reaction. Although IgE is involved in these responses, patients are not at high enough risk to warrant the use of auto injectable epinephrine. When LLRs are frequent and associated with severe disability, venom-specific immunotherapy may be explored.
Clinicians can decrease morbidity from LLRs by assuring patients, avoiding medicines that cause side effects when they are not necessary, and sending patients to an allergist if there are additional concerns, such as frequent impairment.
