Insect bites
Bee and wasp stings can cause life threatening anaphylaxis, previous stings are a risk factor and hence venom allergy is more common in beekeepers and gardeners. Referrals should be made as below. Beekeepers should be advised to give up their hives if they have had anaphylaxis to a bee sting. Select patients will be eligible for immunotherapy/desensitisation.
There are no standardised effective treatments beyond antihistamines for individuals who have a marked response to none bee/wasp stings. e.g. midge/mosquito bites leading to localised inflammation. In such cases insect repellents (e.g. Deet), high dose antihistamines e.g. Fexofenadine 360mg BD and a short supply of prednisolone 30mg OD for 3 days are suggested. There is no additional investigations or therapies that are available and hence we do not appoint these patients.
Routine referral criteria
History of anaphylaxis or systemic symptoms (urticaria, angioedema, wheeze, hypotension) within an hour of a wasp/bee sting.
History of localised reaction (erythema, angioedema at sting site) to bee and/or wasp venom in an individual at high risk of subsequent stings due to occupational exposure e.g. fruit picker, gardener.
Not to refer
Localised reaction (erythema, angioedema at sting site) to a bee and/or wasp in an individual without an occupational risk
Adverse reactions to insects which are not bee or wasps