title: Large local reactions from stinging insects: from epidemiology to management.
abstract: OBJECTIVE
  Large local reactions (LLRs) caused by insect stings have attracted the interest of clinicians for decades, especially because of their possible role as risk factor for subsequent more severe reaction. Nonetheless, the literature on epidemiological and clinical aspects of LLR is fragmentary. Therefore, we aimed at reviewing the data available so far on the argument and the clinical implications.
  
  
  RESULTS
  Our knowledge on the epidemiology and risk factors of LLR relies on studies performed many years ago. All those studies and our personal observation agree on the fact that LLRs are followed by a systemic reaction in not a negligible proportion of patients (10-15%). More recent studies have underlined the possible role of specific immunotherapy, including sublingual, in the treatment and prevention of LLRs.
  
  
  CONCLUSIONS
  LLRs should deserve a detailed diagnostic work-up, just as for systemic reactions. The prescription of autoinjectable adrenaline would seem advisable. Specific research on the predictive role of LLR for systemic reactions is needed, as well as studies assessing the benefits of treating all patients with LLR with immunotherapy.
authors.affiliation: Allergy Clinic, Nuovo Ospedale San Giovanni di Dio, Florence, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Severino
authors.forename: Patrizia
authors.initials: P
authors.lastname: Bonadonna
authors.forename: Giovanni
authors.initials: G
authors.lastname: Passalacqua
mesh_terms: D000286:Administration, Sublingual; D000328:Adult; D000367:Age Factors; D000485:Allergens / Q000276:immunology; D000818:Animals; D003888:Desensitization, Immunologic; D005260:Female; D006801:Humans; D006927:Hymenoptera; D006969:Hypersensitivity, Immediate / Q000453:epidemiology / Q000276:immunology* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D007299:Insect Bites and Stings / Q000453:epidemiology* / Q000276:immunology* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012867:Skin / Q000276:immunology* / Q000473:pathology; D014862:Wasp Venoms / Q000276:immunology
chemical_list: D000485:Allergens; D014862:Wasp Venoms