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Bee sting swelling after 24 hours12/5/2023 Nevertheless, as mentioned, you do have at least some evidence in the literature that this treatment could be effective (see abstract copied below). Thus, there is no definitive answer to your question as to whether or not to administer immunotherapy, but my own opinion would be not to treat at this time. However, the numbers are exceedingly small, but they are all that we have to my knowledge.Īlso serum sickness-like reactions have been reported to hymenoptera venom as reported in the same article mentioned above, and the urticaria could have been a component of such reaction. Thus there is precedence in the literature to do so. Robert Reisman, a nationally recognized authority in hymenoptera allergy, did choose to treat the patients described with venom immunotherapy. Is that reassuring in any way?Ī: The reaction, delayed urticaria and angioedema after an insect sting, that you described has been reported in the literature (see abstract copied below), and the author of this report, Dr. Immunocap testing revealed class 3 to yellow hornet, paper wasp and honey bee as well as class 4 to yellow jacket.ġ) It seems unlikely that an IgE mediated reaction could occur after 1 week but could the history as represented here indicate a delayed IgE-mediated reaction or a T-cell mediated reaction manifesting as urticaria and angioedema?Ģ) Should immunotherapy be offered/recommended given this patient's outdoor occupation and risk for more severe reactions?ģ) Pt was rechallenged soon after above events and experienced no untoward effect. He developed a local reaction but nothing further. ~ 3 weeks after stopping the Prednisone, pt was stung again by what he thinks was a wasp (black). Symptoms eventually subsided with a 1 week course of Prednisone. 3 days later (1 week after the initial sting), he developed urticaria and angioedema of his lips, face and hands unresponsive to antihistamines. This continued for ~ 4 days then subsided. After he was stung he developed a local reaction that swelled mildly and became itchy and irritated. VIT could be consider for this clinical scenario but there is a paucity of data on this patient population.īelow is answer to a previous Ask the Expert question similar to yours: Ī 34 yo pool maintenance worker with no atopic history was seen after a bee sting in my office. Late-onset allergic reactions, including serum sick. Acute renal failure following multiple hornet stings. Sakhuja V, Bhalla A, Pereira BJG, Kapoor MM, Bhusnurmath SR, Chugh KS. Postscript to bee stings: delayed “serum sickness.” Hosp Pract 1983 18:36. The articles I could find were for the late 1980's and may provide some guidance for the treatment of your patient. There is not a lot of data on "delayed reactions" from sting reactions. There is evidence that VIT improves the quality of the patient’s life in patients with cutaneous systemic reactions." VIT is still an acceptable option if there are special circumstances, such as frequent exposure, or lifestyle considerations (potential impairment in quality of life) and must be weighed against added cost and potential inconvenience. Prospective sting challenge studies in adults found a less than 3% chance of a more severe reaction in such people. In a prospective field-sting study of children, there was a 10% chance of having a systemic reaction if re-stung (usually milder than their previous sting reactions), and a 3% or less chance of a more severe reaction. The decision to give VIT for patients with large local reactions must be weighed against the added cost and potential inconvenience." In patients with more local symptoms then "However, immunotherapy is usually not required for patients who have experienced only cutaneous systemic reactions after an insect sting. There is, however, increasing evidence that VIT significantly reduces the size and duration of large local reactions and thus might be useful in affected individuals with a history of frequent un- avoidable large local reactions and detectable venom specific IgE. "Most patients with large local reactions need only symptomatic care and are not candidates for testing for venom specific IgE or venom immunotherapy (VIT). Allergies to insect stings.The recent update on Stinging Insect Hypersensitivity addresses immediate dermal reactions to stings and suggests that large local reactions to a sting can be monitored clinically. Randomized controlled trial of topical aspirin in the treatment of bee and wasp stings. To pee, or not to pee: A review on envenomation and treatment in European jellyfish species. doi:10.7759/cureus.8078Ĭenters for Disease Control and Prevention. Methods of honey bee stinger removal: A systematic review of the literature. National Capital Poison Center: Poison Control.
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