Insect Venom Allergy

Normally, bites and stings of wasps, bees, bumblebees, hornets, mosquitoes or brakes are not dangerous but only painful. But there are people who react with a - sometimes violent - allergic reaction to such an event.

That's the case with around four percent of all Germans. After all, a local response to insect bites that goes beyond the normal range can be found in up to one fifth of all Germans.

The treachery of a sting is that the poison gets through the skin directly into the human, so the body's defense of the skin so bypasses. Therefore, insect venom allergies can occur quite quickly . As always with an allergy , the immune system reacts unnecessarily to an inherently harmless component of the insect venom. These ingredients are called allergens.

Allergic shock often comes in minutes
The first symptoms are in the form of skin redness , a swelling or a burning sensation. If the allergic reaction really gets under way, nausea, headache, shortness of breath and cardiovascular symptoms come along (sometimes very quickly) In this case, it is important to immediately take immediate action, so insect allergies should always have an emergency kit with them.
Of course, the best thing to do is to avoid doing anything by being stung or bitten by an insect. Suitable clothing is just as important as not leaving food open. Of course, a fly screen also helps.

Symptoms of an insect venom allergy
Often it is not so easy to distinguish an insect venom allergy from a normal insect bug response. In both, at first there is redness and swelling of the puncture site, it may itch or hurt.

Strong local skin reaction
In an insect venom allergy, there is usually a very spreading redness. It reaches a diameter of over ten centimeters and lasts for at least 24 hours or longer. It spreads over larger areas of skin and shows symptoms of hives (urticaria): itching, itching wheals on the skin.

Systemic reaction
Not only at the injection site, the symptoms of an insect venom allergy, the entire body reacts. These include nausea and vomiting, diarrhea, shortness of breath and drop in blood pressure. In rare, particularly severe cases, there is a life-threatening allergic (anaphylactic) shock, which can lead to cardiovascular arrest.

Causes of an insect poison allergy
When stinging, insects release various poisons into the puncture site. Usually there are local reactions around the puncture site: mostly localized redness, itching and burning. These are small, acute inflammations.
In an insect venom allergy, the body reacts violently: This is an allergy of immediate type I. The body's defense reacts to the insect venom with a strong production of immunoglobulin E. This antibody is made up of the mast cells, which make the poison harmless and thereby increases distribute the messenger histamine. Histamine leads to acute inflammatory reactions in the body.

Diagnosis of an insect venom allergy
There you first have a conversation with the doctor about the history of the disease (anamnesis). The stitch event is the focus here. Here it is advisable to prepare for the interview by answering some questions in advance. For example, it is helpful if the stinging insect has been clearly identified. If the skin reaction has already disappeared, it is beneficial if you can describe it more accurately.
Following the anamnesis, various skin tests follow. Which skin test is suitable in a particular case, decides the doctor. All tests have in common that the suspected allergen is applied to the skin (on the forearm or on the back). If a corresponding allergic reaction is detected, the suspicion of insect venom allergy is confirmed. In individual cases, various laboratory tests are recommended, which are primarily looking for an increased immunoglobulin E value in the blood.

Therapy of an insect venom allergy
The therapy of an insect venom allergy is to be considered under two aspects:
  • the acute therapy in the case of an insect bite that, if left untreated, can lead to an allergic shock (anaphylaxis), or
  • the specific immunotherapy referred to as hypersensitization for the causal treatment of the overreaction, by habituation of the immune system to the allergy trigger.
Specific immunotherapy: hyposensitization to insect venom

In the case of hyposensitization, the tolerance limit for allergens is increased, so that the body gradually becomes accustomed to insulin poisoning. The period of treatment usually covers several years, in which the lowest doses of insulin poison are injected under the medical supervision of the allergic person.
Allergic therapy by means of hyposensitization is not free of risks, but effective. However, a prerequisite for the patient is: a lot of patience!
A sting from wasp or bee is painful, but normally - depending on the puncture site - but harmless. For some people, however, such a sting can be life-threatening. As others have an allergy to grass pollen or nuts, these patients are allergic to insect venom and respond to the sting not only locally with swelling or redness of the skin, but systemically, so throughout the body. This is called anaphylactic shock when symptoms such as dyspnoea, circulatory problems or even blurred vision occur.

Hyposensitization works for almost all allergies
As with other allergies, it is possible to hyposensitize these patients against their allergen, thereby protecting them from severe allergic reactions. There are numerous treatment protocols in which different individual features can be adapted and scheduled. Conventionally, depot preparations are administered on an outpatient basis However, if it has to be done quickly, perhaps because the insect flying season is around the corner, you can also use a so-called ultra-rush protocol with a watery extract. The therapy with the insect venom is highly effective. But it is also very tedious and can cause significant side effects.

This is how hyposensitization works
In case of hyposensitization, the allergen is injected at regular intervals. Redness and swelling almost always occur at the injection site. In the course of treatment, their intensity usually decreases. Much more serious is the occurrence of systemic anaphylactic reactions (SAR), which are similar in symptoms to anaphylactic shock. Depending on the study, between 3 and 50 percent of treated patients show such a reaction during the induction phase. There are several risk factors for this: for example, such strong reactions are more likely to occur in adults than in children, and in bee venom allergy patients the risk is higher compared to wasp venom patients.
Inappropriate hyposensitization with insect venom for people who take so-called ACE inhibitors such as hypertension. On the other hand, there are no reliable findings about the combination with the use of β-blockers. In an emergency, it may be more dangerous to discontinue the blood pressure medication for the duration of the insect venom treatment than to continue to take it. In these high-risk patients, it may be advisable to initiate hyposensitization on an inpatient basis and to assist with antihistamines.
Hyposensitization takes time. It is recommended that the respective insecticide be regularly administered for at least three years . The end of treatment must be determined individually. And whether a patient is effectively protected or not can only be tested by one method: the stick provocation with a living insect. So far, there are no laboratory tests that provide such reliable results as this direct and unfortunately painful confrontation.
In around 90 percent of patients but suggests the treatment. However, there is no lifelong immunity. In 10 to 20 percent of hyposensitized patients, an anaphylactic reaction occurs again between one and five years after the end of treatment. The allergic person is only really sure if he continues the therapy for life . It is therefore extremely important to identify patients with limited hyposensitivity in order to work with higher doses of the allergen from the start and not stop treatment too soon.

Acute help: emergency kit for insect allergic people
In addition, patients with allergy to insect venom who know that they have an anaphylactic reaction following an insect bite should always have an emergency kit on them
Emergency Assistance: The Epi-Pen is a pre-filled syringe with adrenaline that protects against anaphylactic shock.

The emergency kit includes various medications that can be life-saving in a severe allergic reaction:
  • a potent antihistamine that reduces the immune response to the foreign protein in the insect venom,
  • cortisone preparation that counteracts the acute inflammatory response, as well as
  • Adrenaline (epinephrine), which stabilizes the circulation and swelling.
The emergency kit is subject to prescription. Proper behavior in case of anaphylactic shock and proper handling of the emergency kit will teach those with insect venom allergy, as well as, where appropriate, the parents of affected children in special anaphylaxis training sessions.
As a result of an insect bite occur general reactions such as redness or itching (pruritus) on the whole body, vomiting - alarm or harmless stomach upset? , Diarrhea or dyspnea at night or under stress: what to do? An emergency doctor should be called immediately as the symptoms can be life threatening. Also, patients with insect venom allergy who are prepared for this and use their emergency kit should consult a doctor or call an emergency doctor if anaphylactic reactions occur. In general, a further medical monitoring is necessary because one fifth of all anaphylactic reactions takes a biphasic course with another attack summit after a few hours.

You have to do that in an insect venom allergy emergency
If the insect venom allergy occurs for the first time, usually no emergency kit is available and the application by a layman is also not recommended. That's why you should apply the following First Aid measures:
  • Determine and remove allergy triggersWhere did the insect sting? Is the sting still alive? If so, it may be removed carefully so that no further poison can enter the body.
  • Cooling the injection siteWhether with cold water as an envelope, ice pack, or in the case of insect bites in the throat by means of sucked (food) ice - The cold slows swelling at the injection site. Thus, no vessels are squeezed or relocated the respiratory tract, if the pharynx is willing to
  • Emergency Call
    Anaphylactic shock must be treated by the emergency physician on site with strong medication. An early emergency call is often life-saving.

Prevent an insect venom allergy
Avoiding the allergen, which is also required in other allergies, is of central importance in insect venom allergy. Therefore, all insect venom allergic people should try to protect themselves from insect bites. Nevertheless, they must be prepared for emergencies.
Increased risk of an emergency is faced by people with insect venom allergy, who are more at risk of being stung by insects, such as farmers, foresters, beekeepers, foresters, gardeners or sellers at fruit and vegetable stalls or in bakeries. Bee flying can be expected from spring to autumn and on warm winter days, with larger wasp populations, especially in summer and autumn. While bees are found mostly near beehives and flowers, wasps are often attracted to food and waste.
Among the general measures necessary to part with insect venom allergy to avoid an emergency at leisure activities to be outside careful not barefoot or walk wearing open sandals in the garden or the great outdoors, no color, wide in summer clothes to wear and no perfumed cosmetics to use To pay close attention to insects when picking fruit or flowers, to attach mosquitoes to the windows , to abstain from eating outdoors and to drink from bottles or cans outside not directly, but only with a straw as a precaution. If there is an insect nearby, should be on hectic, beating motions waived and leave the danger area as quiet as possible.
Address the cause of insect venom allergy
For people with an increased risk of anaphylaxis in the case of insect venom allergy, effective, causal treatment is also available with the specific immunotherapy, which can avoid an emergency in the long term. The treatment, which usually takes several years, is effective in about 90 percent of those affected. It promotes the tolerance of the body to the respective insect venom and thus reduces the risk of a potentially fatal, excessive reaction of the immune system. Whether the treatment is useful and - if so - how it is best performed, can be assessed by an allergist.

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