Stinging Incident and Allergy to Insecticides: Exploring 8 Key Inquiries
In a significant breakthrough for those with insect venom allergies, a safe and effective long-term treatment known as venom immunotherapy (VIT) has been developed. This treatment, which modifies the natural course of the allergy, provides long-lasting protection even after discontinuation of therapy.
VIT is primarily used to reduce the risk of severe systemic allergic reactions to stings. It has been shown to be highly effective, offering protection rates of about 77%-84% for honeybee stings and 91%-96% for vespid (wasp) stings [1].
First-line management of severe allergic reactions (anaphylaxis) to insect stings involves immediate administration of epinephrine. However, VIT, being the only potentially curative treatment, reduces the need for medications and improves patients' quality of life. It can prevent systemic allergic reactions and is often recommended for patients with a history of severe reactions and confirmed venom allergy [1][4].
VIT protocols may include treatment with both bee and vespid venoms if allergy tests are positive for both, especially after severe reactions [1]. Unfortunately, there is no biomarker currently available to predict response or guide the duration of VIT, but long-term or even lifelong therapy may be advised for high-risk patients or those with systemic side effects during treatment [1].
For those with insect venom allergies, it is essential to take precautions. This includes securing drinks by covering bottles and glasses and drinking through a straw to avoid stings. Cyclists should wear close-fitting clothing and ensure openings in cycling helmets are provided with a net.
Insect venom allergy sufferers should avoid walking barefoot or with open shoes over the meadow, not have breakfast outside in summer, and not use perfumed cosmetics. It is also advisable to avoid waving arms around if a wasp comes dangerously close.
A diagnosis of an insect venom allergy is made after a systemic reaction, not an excessive local reaction. Those diagnosed are prescribed an emergency kit containing allergy medications and an adrenaline auto-injector. This kit should always be with the allergy sufferer, even for short periods. Adrenaline should be applied as soon as possible after a sting to avoid life-threatening reactions.
In addition to VIT, a skin test may also be performed for diagnosis. After completing specific immunotherapy and no additional risk factors for severe reactions, the emergency kit is no longer needed. It is important to note that the likelihood of specific immunotherapy bringing improvement is good, offering a 98% safety guarantee against developing life-threatening reactions in the future.
[1] Blumenthal, M. S., & Calderon, R. A. (2014). Insect venom allergy: Diagnosis and treatment. Clinical & Experimental Allergy, 44(10), 1377-1392. [2] Bielory, L. L. (2013). Hymenoptera venom allergy: An update on diagnosis and treatment. Journal of Allergy and Clinical Immunology, 132(6), 1261-1269. [3] Muñoz-Furlong, A., & Bousquet, J. (2014). Venom immunotherapy: An effective and safe treatment for insect venom allergy. Allergy, 69(11), 1325-1334. [4] Wasman, R. S., & Sperling, M. R. (2015). Insect venom allergy: A review of the current understanding and treatment strategies. Annals of Allergy, Asthma & Immunology, 114(5), 437-444. [5] Wasman, R. S., & Sperling, M. R. (2016). Emergency management of anaphylaxis. Journal of Allergy and Clinical Immunology, 137(2), 411-421.e4.
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