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Insect bites pose a risk to life for some allergy sufferers
With an insect bite allergy, people with an allergic hypersensitivity react to the poison of certain insects. Wasps and bees are usually the culprits. An insect bite can trigger a life-threatening anaphylactic shock in these allergy sufferers. The most important things in brief:
- definition: With an insect bite allergy, triggered by components of the insect venom, an overreaction takes place in the immune system, which affects the entire body. The reaction to the poison depends on the severity of the allergy.
- Symptoms: Depending on the severity, an insect bite can cause symptoms such as itching and swelling, dizziness, nausea and vomiting, cramps, shortness of breath and weaknesses. In the worst case, there are even life-threatening situations with a rapid drop in blood pressure, collapse and loss of consciousness.
- trigger: Stings from bees and wasps most often trigger the allergic reactions. Bumblebee and hornet stings are also possible triggers, but are far less common. Mosquito bites can also cause allergic reactions, but these are less dangerous.
- causes: The immune system of those affected reacts excessively to the bite and forms antibodies against the allergens contained in the insect venom, which can affect the entire cardiovascular system.
- risk groups: The immune system often becomes sensitive from stitch to stitch. This means that people who are increasingly stung are at risk, such as beekeepers, gardeners, firefighters and fruit growers.
- therapy: The so-called hyposensitization is the only effective causal therapy against insect bite allergies. In addition, those affected should carry an emergency kit with them when they are outdoors.
Different types of allergies
Four different types of allergies are known. The type to which the insect bite allergy is assigned is type I, the immediate type, in which the body reacts within seconds to minutes due to the particularly strong formation of immunoglobulins of the IgE type. Other types of allergy are the type II or cytotoxic type with a reaction time of hours or days, the type III or immune complex type in which the organism reacts to the antigen within six to eight hours and the type IV, also known as the late type , which is characterized by symptoms of allergy within a period of one to three days.
The insect bite allergy is based on a predisposition that can lead to an allergic reaction in the course of life. Upon contact with the allergen, here the poison of an insect, the body produces large amounts of immunoglobulins of the IgE type. These stick to the surface of mast cells (blood cells that belong to the leukocytes). If the affected person comes into contact with an insecticide a second time, the body starts a so-called antigen-antibody reaction, whereupon the mast cells immediately release histamine and other ingredients.
Allergic reactions show up in no time
The allergic symptoms appear within seconds or minutes. With insect bite allergy, this is usually anaphylaxis. After initial itching, reddening and swelling of the puncture site, there are additional symptoms that are no longer local, but can spread more and more throughout the body. These are edema in the face and upper body, shortness of breath and attack-like redness, especially of the face (flush). The released histamine, which has a vasodilatory effect, lowers blood pressure. Abdominal and abdominal cramps can also develop.
In extreme cases, anaphylaxis can result in life-threatening anaphylactic shock. This goes hand in hand with loss of consciousness, pulse acceleration and drop in blood pressure until ultimately cardiovascular failure and respiratory arrest can occur.
Trigger for an insect bite allergy
The main triggers for an insect bite allergy are the poison of the honeybee and the wasp. Bumblebees and hornets are large, frightening insects, but they are less likely to be stung by these species. Wasps are more aggressive when it comes to puncturing. As a rule, these do not lose their sting, as is the case with bees. Furthermore, mosquito bites can cause allergic reactions. While these are very uncomfortable, they are not as dangerous as the immune response to bee and wasp venom.
Symptoms of insect bite allergy
In the symptoms of insect bite allergy, a distinction is made between local reactions and general reactions. Local reactions include redness, itching, itchy rash and swelling at the injection site. This can intensify and last for several days. General reactions do not occur near the sting, but can affect the whole body. Slight manifestations include flushing of the face, nausea, dizziness and difficulty breathing. The more pronounced general symptoms include persistent, massive nausea and vomiting, and rapid heartbeat. In the worst case, an insect bite allergy can lead to life-threatening situations with shortness of breath, rapid drop in blood pressure, collapse, loss of consciousness and even cardiac arrest.
In order to diagnose an insect bite allergy, a detailed medical history is necessary. Affected people are asked exactly what the stitch is and how it runs. A subsequent allergy test, in which the smallest amounts of bee and wasp venom are introduced into the skin with the help of a lancet, can substantiate the suspicion of an insect bite allergy. This is usually followed by a blood test in which the number of type E immunoglobulins is determined.
The drug treatment of an insect bite allergy is not a causal, but a pure symptom treatment. However, this is extremely important in order to get the allergic reactions under control as quickly as possible and to counter an anaphylactic shock. Medications used include antihistamines, glucocorticoids and mast cell stabilizers.
The influence of histamine
Histamine is a substance that the body produces itself. In the event of allergen contact, histamine is released from the mast cells, which leads to a wide variety of unpleasant allergy symptoms. Sagging of the vascular muscles, which is noticeable by a drop in blood pressure, increased vascular permeability, which causes swelling, both locally and throughout the body, and impairment of the intestinal mucosa, which can lead to diarrhea. All of these are symptoms caused by the released histamine.
This is where the use of an antihistamine comes into play. This does not affect the release and breakdown of the substance, but blocks the receptors in the body that histamine attacks. Mast cell stabilizers, on the other hand, intervene in the mechanism of histamine release by stabilizing the cell walls of the mast cells. Glucocorticoids, which are also used in the treatment of insect bite allergy, have an anti-inflammatory effect, which is very important, especially with allergic symptoms.
Since histamine is not the only responsible substance in an insect bite, other antagonists such as alpha or beta sympathomimetics are also used. In anaphylactic shock, the most important remedy is adrenaline. This has an expanding effect on the bronchi and increases blood pressure. A ready-made emergency syringe that contains adrenaline, called an auto-injector, is part of every emergency kit that people with insect bite allergies should have at hand whenever possible, as it is life-saving in an emergency.
The avoidance strategy is of course the best way to avoid an allergic reaction. However, this is of course not always possible. These measures can help protect against insect bites:
- dress: Those affected should protect themselves with suitable clothing and always wear shoes when they are moving in the garden.
- Outdoor dining: Extreme caution is required when eating ice cream, cakes and the like.
- Fruits and flowers: Picking fruit or flowers should be reserved for people who are not allergic to insect bites.
- Perfume: Perfumed cosmetics should be avoided if possible, because the insects love fragrances and can be attracted by them.
- Insect screen: An insect screen protects you from the window at night.
- motorcycle: To protect against insect bites, it is best to wear tight-fitting clothing and always keep the helmet visor closed.
Those affected should always carry the emergency kit with them. It is also important to inform friends and acquaintances of the allergy so that they can immediately recognize the emergency situation and act accordingly in the event of a sting. The use of the emergency kit does not save you from alerting the emergency doctor.
Hyposensitization in insect bite allergy
Since an insect bite can never be ruled out in life, causal treatment in the form of specific immunotherapy is recommended. In the event of hyposensitization, the organism is confronted with continuously increasing doses of the insecticide, in the form of an injection. The immune system then slowly gets used to the poison.
This treatment is not entirely harmless. The start of therapy is therefore carried out in hospital in order to be able to act immediately in the event of an overreaction. The basic treatment usually takes five to ten days. It starts with a very low dose of insect venom and then increases it gently, in the smallest steps.
High chances of success
Thereafter, the therapy can be carried out on an outpatient basis, but always under medical supervision. Patients have to stay in the practice for at least half an hour after each injection so that the doctor can intervene quickly. The complete hyposensitization takes between three and five years. This therapy offers 95 percent certainty and can take place from the age of five.
Emergency measures for an insect bite
The measures listed below should be followed when an emergency situation arises. Affected persons should also inform friends, relatives and colleagues about them so that they can react properly in an emergency if the persons affected are no longer able to do so themselves. These measures include:
- keep Calm: This is extremely important to successfully complete the next steps. A panic attack would only make the situation worse.
- Emergency doctor: Call an emergency doctor immediately.
- Emergency set: If you have an existing emergency kit that contains both an antihistamine and a glucocorticoid, as well as adrenaline, it should be used immediately before the doctor comes. As soon as the first symptoms appear, adrenaline should be used first. Then the other two medicines are given. Every affected person should be instructed in the use of their emergency kit before using it for the first time.
- Cool the injection site: The puncture site should also be cooled. If an insect is swallowed, the sucking of ice cubes is recommended, but only as long as those affected are conscious.
Emergency medication from naturopathy
Under no circumstances should the emergency kit and emergency doctor be dispensed with in the event of an insect bite allergy. However, homeopathy has three remedies that can also be used in such an emergency. The homeopathic remedy Apis helps with both wasp and bee stings. Vespa, on the other hand, is only used for wasp stings. Usually it is used orally. However, the agent can be dissolved in a little water and thus the injection site can be supplied. The general, sudden onset of emergency requires aconite. These funds, like the emergency kit, should always be carried with you.
- Home remedies for wasps: Use these measures to drive away wasps.
- Some wasp stings can also be life-threatening for non-allergy sufferers: There is also a danger for non-allergy sufferers if they are stung in the mouth or throat area.
- Rapid help against wasp and bee stings in children: What to consider if children are stung by wasps or bees.
- Many underestimate insect venom allergy: Expert reports on treatment options for insect bite allergy.
- Bee and wasp stings can be fatal: Bavarian State Minister for Health Melanie Huml advises caution in wasp and bee stings.
- How to protect yourself from wasps: Expert tips for the prevention of wasp stings.
- Institute for Quality and Efficiency in Health Care (IQWiG): Insect venom allergy (accessed: July 24, 2019), gesundheitsinformation.de
- German Society for Allergology and Clinical Immunology (DGAKI): S2k guidelines for bee and wasp venom allergy, diagnosis and therapy, as of March 2011, awmf.org
- Trautmann, Axel / Kleine-Tebbe, Jörg: Allergology in clinic and practice: Allergens - Diagnostics - Therapy, Thieme, 2nd edition, 2013
- European Center of Allergy Research Foundation (Stiftung ECARF): Insect venom allergy (accessed: July 24, 2019), ecarf.org
- Przybilla, Bernhard; Ruëff, Franziska: Insect bites, Dtsch Arztebl Int, 2012, aerzteblatt.de
- National Health Service UK: Overview - Insect bites and stings (access: July 24, 2019), nhs.uk
- American College of Allergy, Asthma & Immunology: Insect Sting Allergy (accessed: July 24, 2019), acaai.org
- Asthma and Allergy Foundation of America: Insect Allergies (accessed: July 24, 2019), aafa.org
Author and source information
This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Susanne Waschke, Barbara Schindewolf-Lensch
ICD codes for this disease: T63ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.