title: Insect stings: clinical features and management.
abstract: BACKGROUND
  In human beings, local and systemic reactions can be caused both by blood-sucking insects and by venomous insect stings. In Central Europe, the insects that most commonly cause such reactions are honeybees, certain social wasps, mosquitoes, and flies.
  
  
  METHODS
  This article is based on a selective literature review, including guidelines from Germany and abroad.
  
  
  RESULTS
  Insect venom induces a toxic reaction at the site of the sting. Large local reactions are due to allergy and occur in up to 25% of the population; as many as 3.5% develop IgE-mediated, potentially life-threatening anaphylaxis, of which about 20 people die in Germany each year. Mastocytosis is found in 3% to 5% of patients with sting anaphylaxis, rendering these patients prone to very severe reactions. Blood-sucking by hematophagous insects can elicit a local allergic reaction, presenting as a wheal or papule, in at least 75% of the population. Large local reactions may ensue, but other diseases are rare. The acute symptoms of an insect sting are treated symptomatically. Patients who have had a systemic reaction or a large local reaction due to insect allergy must take permanent measures to avoid further allergen contact, and to make sure they can treat themselves adequately if stung again. Most patients with systemic anaphylactic reactions to bee or wasp stings need specific immunotherapy.
  
  
  CONCLUSIONS
  Insect stings can cause severe disease. Anaphylaxis due to bee or wasp stings is not a rare event; specific immunotherapy protects susceptible persons from further, potentially life-threatening reactions.
authors.affiliation: Clinic and Policlinic for Dermatology and Allergology, Ludwig-Maximilians-Universität, Munich. Bernhard.Przybilla@med.uni-muenchen.de
authors.forename: Bernhard
authors.initials: B
authors.lastname: Przybilla
authors.forename: Franziska
authors.initials: F
authors.lastname: Ruëff
mesh_terms: D000707:Anaphylaxis / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control*; D018926:Anti-Allergic Agents / Q000627:therapeutic use*; D001993:Bronchodilator Agents / Q000627:therapeutic use; D004837:Epinephrine / Q000627:therapeutic use*; D006634:Histamine H1 Antagonists / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007299:Insect Bites and Stings / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*
chemical_list: D018926:Anti-Allergic Agents; D001993:Bronchodilator Agents; D006634:Histamine H1 Antagonists; D007166:Immunosuppressive Agents; D004837:Epinephrine