Allergy Capital

European Wasp (left); honey bees (centre left); Jaws of the Jack Jumper Ant (centre right). Illustrations courtesy of the CSIRO Division of Entomology, Canberra. Paper wasp (far right)

Adverse Reactions to Bites and Stings

Stings from honey bees, wasps and the Australian Jumper ant are common. Serious reactions are relatively rare. What do you do when more nasty reactions such as anaphylaxis occur?

Revised 28 January 2006

IMPORTANT The information provided is of a general nature and should not be used as a substitute for professional advice. If you think you may suffer from an allergic or other disease that requires attention, you should discuss it with your family doctor.

Bugs that bite
Mosquitoes and "march flies" can cause nasty itchy bites, but serious allergic reactions are very rare. Ticks also bite, and occasional life-threatening reactions due to tick allergy have been reported. One of the most common causes of severe irritating reactions is from contact with the spines of caterpillars.

Stinging Insects
The Honey Bee is the commonest cause of allergic reactions in Australia. Most bites and stings result in a localized itch and swelling that settles within a few days. Native Australian bees and the Green Ant of Queensland can also cause allergic reactions. Unlike bees, Paper wasps and European wasps can sting multiple times, and the latter is particularly aggressive. The "Jumper Ant" is a large black bull-ant prevalent down the eastern side of Australia and Tasmania, as well as the Adelaide Hills and some parts of Western Australia. It is a "hopping" ant, is very aggressive, and can cause severe local pain and allergic reactions. The venoms of these insects are very different. Allergy to one does not increase the risk of reaction to another.

Type of Reactions
Most bites and stings result in a localized itch and swelling that settles within a few days. Some will trigger large local swelling that can last for days, and sometimes be mistaken for an infection. More severe allergic reactions can also occur, a condition known as anaphylaxis. Symptoms may include an all-over rash, swelling of tongue or throat, trouble breathing, gut cramps, diarrhoea, vomiting or even a drop in blood pressure. When more severe allergic reactions occur, bees, wasps or "Jumper ants" are usually responsible. Once severe allergy to these insects is established, the tendency to have severe reactions usually persists.

Natural History of Allergic Reactions
Local reactions to biting insects like mosquitoes tend to become less severe with time, even if they are very large. Only sometimes do non-dangerous localised allergic reactions become worse, and the outcome is generally better in children than in adults. Unfortunately, serious allergic reactions to stinging insects tend to persist.

Preventing Stings and Bites

Bites from midges and mosquitoes are best avoided by covering up as much as possible. Avoid being out doors in the early morning or at dusk, and use a DEET-containing insect repellent like "Rid".
Nightly checks for ticks may help if you live in an endemic area. See additional information on tick allergy.
Honey Bees are gentle and normally only sting in self-defense. The best protection is light colored clothing, covering much of the body (particularly the feet) and avoiding scents.
Wasps tend to nest in logs, walls or underground. They are generally more aggressive than bees and attracted to food and drink.
Don't pretend to be a flower! Avoid bright colored & black clothing, and don't wear scents. Cover the body (especially the feet) and wear muted colors like white, tan or green.
Avoid provoking bees and wasps, have nearby nests removed by professionals, and drive with the windows up and air-conditioner on.

Management of Bites and stings
First Aid. Bees usually leave their barbed sting in the skin and die. Flicking the sting out as soon as possible will reduce the amount of venom injected. (By contrast, wasps and bull ants rarely leave their sting in the skin). Cold packs and soothing creams may help. Sometimes oral medicines like antihistamines or steroids are helpful, but they generally take one or more hours to help, might help local reactions but will not prevent the rapid onset of a dangerous allergic reaction.

Patient with life-threatening (anaphylactic) reactions are usually advised to

Seek urgent medical assistance
Carry injectable adrenaline to treat severe allergic reactions
Undertake a course of immunotherapy (desensitization) injections to "switch off" the allergic reaction over time. This is effective for the treatment of bee and wasp stings. This usually requires a series of injections of purified insect venom, typically 80-100 over a period of 5 years. At this point in time, there is no vaccine to switch off serious allergic reactions to Jumper ant allergy, but research is ongoing.

Related articles

Links to more information about allergy to stinging insects

These links to articles on stinging insect allergy are external to this web site:

Australasian Society for Clinical Immunology and Allergy

American Academy of Allergy, Asthma and Immunology

References
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