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Insect Stings and Bites | Pediatrics Clerkship | The University of Chicago - Local Reaction Without a History of Sting Allergy |
Prednisone dose for bee sting. Insect Sting Allergy (Ant, Wasp or Bee Stings): Treatment
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❿Insect Sting Allergy Treatment | Ant, Wasp and Bee Sting Allergy Treatment - Before Using
Go to whole of WA Government Search. They are not strict protocols, and they do not replace the judgement of a senior clinician. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient.
Clinicians should also consider the local skill level available and their local area policies before following any guideline. There is little immunologic cross-reactivity between the venom of bees and wasps, and a history of allergy or anaphylaxis to one doesn't imply a risk of reaction to the other. Bees sting only once, leaving the sting and poison sac in the victim, after which the bee dies.
Wasps can sting multiple times, don't leave their sting in the victim, and don't die after stinging. Large local reactions do not confer a significantly higher risk of anaphylaxis upon future exposure. Allergic reactions - these are generally IgE-mediated, and reflect previous sensitisation. This is rare in Australia. Delayed serum sickness - this may occur days after the sting, with morbiliform rash, uticaria, myalgia, arthralgia and low grade fever.
This document can be made available in alternative formats on request for a person with a disability. Skip to main content Skip to navigation Site map Accessibility Contact us. Search this site. Search all sites. Background Bees, wasps and ants belong to the insect order Hymenoptera Stings are common in children, particularly during spring and summer Native Australian bees rarely sting; the introduced honeybee and to a lesser extent, the European wasp is responsible for the majority of problematic insect stings Allergic reactions to bull ants, especially Jack Jumper ants Myrmecia genusare an increasing concern in eastern Australia.
March flies and ticks may cause similar reactions. Airway and circulatory symptoms are unlikely. Gastrointestinal symptoms vomiting, diarrhoea predominate. Renal failure due to release of tissue breakdown products may complicate multiple stings bee or wasp several days after the event Treatment is supportive Delayed serum sickness - this may occur days after the sting, with morbiliform rash, uticaria, myalgia, arthralgia and low grade fever.
Management The majority of children who are stung will not need any medical treatment. First aid for stings Remove sting if present as quickly as possible, by scraping with the edge of a flat object long fingernail, knife blade Analgesia - Simple analgesics and a cold compress applied to the sting site may relieve pain Anaphylaxis - this is a medical emergency.
Refer to Anaphylaxis Local symptoms Symptoms often resolve in a few hours and an oral analgesic and cold compress may be helpful Oral antihistamines may alleviate itch and may prevent progression to systemic reactions in children with a previous history of systemic reactions to insect stings.
Large local reactions commonly peak at hours and may persist for several days. Elevate the affected limb and apply a cold compress. The appearance may resemble cellulitis but antibiotics should be avoided unless swelling increases more than 48 hours after the sting or systemic signs suggest secondary infection.
Minor allergic symptoms - general urticaria, pruritus or angio-oedema An oral antihistamine is recommended doses as above The child should be closely watched over the next hours for signs of anaphylaxis. The majority of children who die from insect stings have no prior history of anaphylaxis. It should be administered if the child develops any signs of anaphylaxis.
Australian Medicines Handbook Pty Ltd. Accessed, up to date. Fleisher, Gary R. Ludwig, Stephen. Textbook of Pediatric Emergency Medicine, 6th Edition. Related guidelines Anaphylaxis. Back to top. Allergic reactions - these are generally IgE-mediated, and reflect previous sensitisation Usually mild and non-life threatening. Generalised urticaria, pruritus and angio-oedema are typical Anaphylaxis : Airway oedema, bronchospasm and vasogenic shock require emergency treatment.
Renal failure due to release of tissue breakdown products may complicate multiple stings bee or wasp several days after the event Treatment is supportive.
First aid for stings Remove sting if present as quickly as possible, by scraping with the edge of a flat object long fingernail, knife blade Analgesia - Simple analgesics and a cold compress applied to the sting site may relieve pain. Anaphylaxis - this is a medical emergency. Refer to Anaphylaxis. Local symptoms Symptoms often resolve in a few hours and an oral analgesic and cold compress may be helpful Oral antihistamines may alleviate itch and may prevent progression to systemic reactions in children with a previous history of systemic reactions to insect stings.
❾-50%}Prednisone (Oral Route) Proper Use - Mayo Clinic
Skip to main content. Pediatrics Clerkship The University of Chicago. Insect Stings and Bites. Reactions to Stings Localized reactions Can be divided into uncomplicated and large local reactions Uncomplicated local reactions usually cause pain at the site and localized swelling and redness cm in diameter and resolve within approximately 2 days; these should be treated with cold compresses Uncomplicated local reaction 1 day later.
May represent an IgE mediated reaction; individuals with large reactions often have positive skin tests. Anaphylaxis There are no reliable predictors of who will react with an anaphylactic reaction. The incidence of anaphylaxis is rare in subsequent stings, and immunoprophylaxis is not recommended. Often there is a history of atopy, and there is a higher incidence in young males, which may reflect an increased exposure.
Systemic reactions to skin tests are rare. Radioallergosorbent tests, a measure of specific IgE, are available but are less sensitive and more expensive than skin testing. Anaphylaxis Treatment Initial ABC' s - Oxygen, airway protection and intubation if necessary, fluid maintenance if there is circulatory collapse. Antihistamines If there is no response to initial treatment, IV steroids may be necessary.
Bees sting only once, leaving the sting and poison sac in the victim, after which the bee dies. Wasps can sting multiple times, don't leave their sting in the victim, and don't die after stinging.
Large local reactions do not confer a significantly higher risk of anaphylaxis upon future exposure. Allergic reactions - these are generally IgE-mediated, and reflect previous sensitisation. This is rare in Australia. Delayed serum sickness - this may occur days after the sting, with morbiliform rash, uticaria, myalgia, arthralgia and low grade fever.
This document can be made available in alternative formats on request for a person with a disability. Skip to main content Skip to navigation Site map Accessibility Contact us. Search this site. Search all sites.
Background Bees, wasps and ants belong to the insect order Hymenoptera Stings are common in children, particularly during spring and summer Native Australian bees rarely sting; the introduced honeybee and to a lesser extent, the European wasp is responsible for the majority of problematic insect stings Allergic reactions to bull ants, especially Jack Jumper ants Myrmecia genus , are an increasing concern in eastern Australia.
Download citation. Received : 17 June Accepted : 16 October Published : 24 October Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search all BMC articles Search. Download PDF. Case presentation We present the case of a 47 years old woman allergic to bee venom who experienced two severe SRs after bee stings and several SRs to VIT with bee venom.
Conclusions The search of the dose of omalizumab able to protect a patient with repeated SRs to VIT may be demanding, but this search is warranted by the need to provide to this kind of patient, by an adequate VIT, the protection from potentially life-threatening reactions. Background Venom immunotherapy VIT is generally safe and, differently from injective immunotherapy with inhalant allergens, no fatal reaction to treatment has been reported [ 1 ].
Case presentation The patient is a woman exposed to honeybee stings because her father is a beekeeper. Table 2 Previous attempts of buildup phase with HB venom Full size table. Table 3 Build up phase with administration of omalizumab Full size table. Conclusions VIT is a highly effective treatment but not all patients are protected from SRs by the usual maintenance dose of mcg.
Acknowledgements None. Competing interests E. Consent for publication Signed consent to publish was obtained from the patient. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals.
For non-prescription products, read the label or package ingredients carefully. Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of prednisone in children.
However, pediatric patients are more likely to have slower growth and bone problems if prednisone is used for a long time. Recommended doses should not be exceeded, and the patient should be carefully monitored during therapy. Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of prednisone in the elderly. However, elderly patients are more likely to have age-related liver, kidney, or heart problems, which may require caution and an adjustment in the dose for elderly patients receiving prednisone.
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Insects that sting belong to the order Hymenoptra. The families within this group include Vespidae e. Insects tend to sting primarily as self-defense or to protect their nests, however, members of the Vespidae family as well as Africanized honeybees are occasionally more aggressive and might sting to obtain food.
The stinging apparatus, called the aculeus, is found only on females. The aculeus has a variable number of barbs—depending on the species—that results in its becoming stuck in the flesh of the animal into which it was impaled, allowing for a prolonged release of venom from the attached sac.
Once stuck in its victim, the detachment of the aculeus results in the death of the insect. Species with fewer barbs, however, can sting multiple times. Fire ants can grasp onto their victims with their pinchers, allowing them to sting repeatedly. Removing the aculeus after it has been impaled is necessary to both minimize venom injection and to prevent foreign body reactions; ideally removal should be done in less than 2 seconds, as this is the length of time it takes for venom to empty from the attached sac.
The reaction to a sting is due to changes in permeability of blood vessels and to the reaction produced to the introduction of protein antigens that may lead to the production of IgE. Uncomplicated local reaction 1 day later. Skip to main content. Pediatrics Clerkship The University of Chicago. Insect Stings and Bites. Reactions to Stings Localized reactions Can be divided into uncomplicated and large local reactions Uncomplicated local reactions usually cause pain at the site and localized swelling and redness cm in diameter and resolve within approximately 2 days; these should be treated with cold compresses Uncomplicated local reaction 1 day later.
May represent an IgE mediated reaction; individuals with large reactions often have positive skin tests. Anaphylaxis There are no reliable predictors of who will react with an anaphylactic reaction. The incidence of anaphylaxis is rare in subsequent stings, and immunoprophylaxis is not recommended.
Often there is a history of atopy, and there is a higher incidence in young males, which may reflect an increased exposure. Systemic reactions to skin tests are rare. Radioallergosorbent tests, a measure of specific IgE, are available but are less sensitive and more expensive than skin testing.
Anaphylaxis Treatment Initial ABC' s - Oxygen, airway protection and intubation if necessary, fluid maintenance if there is circulatory collapse. Antihistamines If there is no response to initial treatment, IV steroids may be necessary.
Prevention of Stings Decrease exposure with clothing, wearing dark colors, decrease use of fragrances when outside, and use of insect repellents Be careful when cooking outside because of attraction of insects Bracelets to identify individual as reactors to stings.
Immunotherapy Immunotherapy may be given at intervals for up to three years. Reversion to a negative skin test is a good marker of successful treatment It should be considered particularly in the case of bee stings. The mechanism is to increase the amount of IgG specific anti-venom and lower the amount of IgE.
Epi-Pen kits should be kept on the person and at their school for use if needed. Note now Auvi-Q is available, an audio voice recorded autoinjector that walks families through how to administer it Click below on the Video to show families how to use the autoinjectors BELOW.
Other Bites Unlike stings, bites from insects such as mosquitoes, cause only localized swelling and pruritis. Anaphylactic reactions are very unusual. Local care measures such as topical steroids and antihistamines are usually sufficient. References Golden D et al. Hymenoptera Stings. Pediatrics in Review Freeman T. Hypersensitivity to Hymenoptera Stings. Insect Stings. Pediatrics in Review. Insect Bites and Stings. Last accessed April Demain, Jeffrey G.
Minaei, and James M. Anaphylaxis and insect allergy. Current opinion in allergy and clinical immunology Back to Table of Contents. Search Search. Download the Clerkship App. Comer Parents Website. Share this page. A-Z Index.
The stinger of a black honey bee, torn from the bee's body and attached to a topical steroids, and even a single oral dose of mg prednisone have. When visible a bee or wasp sting may be removed carefully. of a short course of steroids like prednisolone pills to be taken for three to five days. Prednisone (Deltasone, Rayos) Prednisone may decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. Prednisone is a corticosteroid (cortisone-like medicine or steroid). It works on the immune system to help relieve swelling, redness, itching, and allergic. oral prednisolone 2–5 mg/kg or. oral betamethasone mg. >30 kg: oral prednisolone 2–5 mg/kg or. Table 3 Build up phase with administration of omalizumab Full size table.Clinical and Molecular Allergy volume 14 , Article number: 14 Cite this article. Metrics details. In patients with repeated SRs to VIT it is difficult to reach the maintenance dose of venom and pre-treatment with omalizumab is indicated, as shown by some studies reporting its preventative capacity, when antihistamines and corticosteroids are ineffective.
We present the case of a 47 years old woman allergic to bee venom who experienced two severe SRs after bee stings and several SRs to VIT with bee venom. Pre-treatment with antihistamines and corticosteroids as well as omalizumab at doses up to mg was unsuccessful, while an omalizumab dose of mg finally achieved in our patient the protection from SRs to VIT with mcg of bee venom.
The search of the dose of omalizumab able to protect a patient with repeated SRs to VIT may be demanding, but this search is warranted by the need to provide to this kind of patient, by an adequate VIT, the protection from potentially life-threatening reactions. Venom immunotherapy VIT is generally safe and, differently from injective immunotherapy with inhalant allergens, no fatal reaction to treatment has been reported [ 1 ]. Still, systemic reactions SR may occur, with a rate significantly higher for honeybee than for vespid VIT.
In fact, a systematic review defined a rate of SRs of In patients with repeated SRs it is difficult to reach the maintenance dose of venom, usually corresponding to mcg [ 1 ].
Mild to moderate SRs may be averted by pre-treatment with antihistamines [ 3 ], while for severe SRs pre-treatment with omalizumab is indicated, as shown by some studies reporting its preventative capacity [ 4 — 6 ].
However, a negative study was published [ 7 ]. We describe the case of a patient with repeated SRs to honeybee VIT who initially was apparently not responsive to the omalizumab treatment but achieved the complete prevention of SRs by dose increase. The patient is a woman exposed to honeybee stings because her father is a beekeeper. At the age of 22 years she experienced a SR of grade 4 severity according to Mueller [ 8 ] after a single bee sting. Honeybee venom hypersensitivity was then diagnosed by skin tests and VIT for bee venom was started.
No other stings until the age of 47 years when the patient had a further SR again grade 4 according to Mueller after a bee sting. According to clinical history, no additional allergy neither other medical conditions were present.
In , VIT for bee venom was then scheduled by honeybee venom from Stallergenes Antony, France but already during the build-up phase, at the dose of 10 mcg of venom, a SR with angioedema of the glottis, cough, itching of hands and feet occurred, requiring epinephrine administration for resolution of the symptoms Table 2. Premedication with terfenadine mg twice a day in the three days before VIT was attempted but anaphylaxis occurred again at the dose of 10 mcg and administration of epinephrine was again necessary.
Omalizumab mg was administered twice with a 14 day interval during the build-up phase of VIT with a modified rush schedule at weekly interval Table 3. However, when reaching the dose of 10 mcg the patient had cough and dysphagia.
This suggested to step down omalizumab to mg every 2 weeks and using oral premedication with prednisone 25 mg, rupatadine 10 mg and ranitidine mg. VIT and omalizumab administrations were set on different days. However, when omalizumab was reduced to mg once a month a SR requiring epinephrine occurred. Therefore, the dose of omalizumab was doubled to mg once a month along with the oral premedication with the usual drugs letting the patient tolerating the monthly dose of mcg of bee venom.
Finally, when increasing the dose of omalizumab to mg monthly, 2 days before VIT, preceded by oral premedication with prednisone, rupatadine and ranitidine 12 and 2 h before VIT, the patient no longer suffered from SRs over the last 14 months and is still under regular treatment.
VIT is a highly effective treatment but not all patients are protected from SRs by the usual maintenance dose of mcg. Rueff et al. The case we report shows that also the search of the dose of omalizumab able to protect a patient with repeated SRs to VIT may be demanding, but this pursuit is warranted by the need to provide to this kind of patient, by an adequate VIT, the protection from potentially life-threatening reactions.
In previous reports, the minimal effective dose of omalizumab to protect from systemic reactions to VIT was mg [ 10 ], thus the search of the protective dose should start from mg, with increase to mg and, possibly, to mg in case of incomplete protection. The most appropriate combination therapy including also corticosteroids and antihistamines is not yet established and needs be investigated. Venom immunotherapy for preventing allergic reaction to insect stings. Safety of hymenoptera venom immunotherapy: a systematic review.
Expert Opin Pharmacother. Analysis of safety, risk factors and pretreatment methods during rush hymenoptera venom immunotherapy. Int Arch Allergy Immunol. Intolerance of specific immunotherapy with Hymenoptera venom: jumping the hurdle with omalizumab.
Severe anaphylaxis to bee venom immunotherapy: efficacy of pre-treatment and concurrent treatment with omalizumab. J Investig Allergol Clin Immunol. Kontou-Fili K. High omalizumab dose controls recurrent reactions to venom immunotherapy in indolent systemic mastocytosis. Article Google Scholar. Failure of omalizumab treatment after recurrent systemic reactions to bee-venom immunotherapy.
Mueller HL. Diagnosis and treatment of insect sensitivity. J Asthma Res. Patients still reacting to a sting challenge while receiving conventional Hymenoptera venom immunotherapy are protected by increased venom doses. J Allergy Clin Immunol. Treatment with a combination of omalizumab and specific immunotherapy for severe anaphylaxis after a wasp sting.
Int J Immunopathol Pharmacol. Download references. You can also search for this author in PubMed Google Scholar. Correspondence to Elisa Boni. Reprints and Permissions. Boni, E. Dose-dependence of protection from systemic reactions to venom immunotherapy by omalizumab. Clin Mol Allergy 14 , 14 Download citation. Received : 17 June Accepted : 16 October Published : 24 October Anyone you share the following link with will be able to read this content:.
Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search all BMC articles Search. Download PDF. Case presentation We present the case of a 47 years old woman allergic to bee venom who experienced two severe SRs after bee stings and several SRs to VIT with bee venom. Conclusions The search of the dose of omalizumab able to protect a patient with repeated SRs to VIT may be demanding, but this search is warranted by the need to provide to this kind of patient, by an adequate VIT, the protection from potentially life-threatening reactions.
Background Venom immunotherapy VIT is generally safe and, differently from injective immunotherapy with inhalant allergens, no fatal reaction to treatment has been reported [ 1 ]. Case presentation The patient is a woman exposed to honeybee stings because her father is a beekeeper. Table 2 Previous attempts of buildup phase with HB venom Full size table. Table 3 Build up phase with administration of omalizumab Full size table.
Conclusions VIT is a highly effective treatment but not all patients are protected from SRs by the usual maintenance dose of mcg. Acknowledgements None.
Competing interests E. Consent for publication Signed consent to publish was obtained from the patient. View author publications. About this article. Cite this article Boni, E. Copy to clipboard. Contact us Submission enquiries: Access here and click Contact Us General enquiries: info biomedcentral.
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