The Examination Of Insect Sting Allergy
By Alisha Dhamani
One or more prior severe reactions to an insect sting place you at an increased risk of severe reactions with each sting.
It is important to let the health care provider know that you have been stung and whether you have had reactions in the past. Be prepared to tell the health care provider all of the medications you have taken for the sting, both prescription and over-the-counter. Don't forget any herbal preparations or other treatments you may have taken.
Physical examination is the most important part of the evaluation of insect stings. Your blood pressure and pulse will be checked to make sure you are not in shock.
Examination should also include the skin for swelling and hives, the lungs for wheezing, and the upper airway for possible swelling or obstruction. An ECG or chest x-ray may be helpful but is not needed in every case. Laboratory tests are usually not helpful. For most insect stings, home care is all that is necessary.
If the stinger is still lodged in the skin, as it usually is after honeybee stings, it should be removed promptly. You can do this by scraping the site with a credit card or similar device, perpendicular to the skin. A fingernail can be used. Pinching the stinger to pull it out is not advised, because this may inject more venom.
If the sting is on the hands or feet where rings or other tight-fitting jewelry is worn, these should be removed immediately before swelling develops, to avoid any compression of the blood supply to these areas.
Take an antihistamine pill, such as diphenhydramine (Benadryl). This helps counteract one of the mediators of the reaction and will help control itching. Diphenhydramine is available without a prescription. Caution - this medication makes most people too drowsy to drive or operate machinery safely. It can be taken every 6 hours for the first few days, until the swelling begins to improve.
Hydrocortisone cream, available over-the-counter, can be applied to the site of the insect sting to relieve itching. A paste of baking soda or salt and water, rubbed on the skin, may provide relief.
For more severe reactions, self-treatment is not recommended. Call your health care provider or 911, depending on the severity of your symptoms. Do not attempt to drive yourself. If no one is available to drive you right away, call for an ambulance.
If you are wheezing or having difficulty breathing, use an inhaled bronchodilator such as albuterol (Proventil) or epinephrine (Primatene Mist) if one is available. These inhaled medications dilate the airway.
If you have been given an epinephrine kit, inject yourself as you have been instructed. The kit provides a premeasured dose of epinephrine, a prescription drug that rapidly reverses the most serious symptoms.
Bystanders should administer CPR to a person who becomes unconscious and stops breathing or does not have a pulse. If at all possible, you or your companion should be prepared to tell medical personnel which medications you have taken today, which you usually take, and any known allergies.
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