Insect bite

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Wasp sting in the scanning electron microscope

An insect sting is an act of defense by insects armed with a poison sting , mostly hymenoptera such as honey bees , wasps and hornets , and more rarely ants . A poisonous secretion is injected under the skin of the enemy with the sting. It can be the immediate defense reaction of an individual insect, but it can also be the collective reaction to a threat to the nesting site.

Normally, the human body reacts to the sting poison (such as bee or hornet poison ) from these insects , but there is also a risk of an allergic reaction in a small group of susceptible people .

Direct sting reaction

Classification according to ICD-10
T63 Toxic effect through contact with poisonous animals
T63.4 Poison other arthropods
Insect bite or sting, poisonous
ICD-10 online (WHO version 2019)
Local sting reaction
Wasp sting - massive swelling after 2 days

The stinging poison from bees and wasps causes pain and, later on, itching and swelling (sometimes massive for allergy sufferers) that only subsides after a few days. This can last up to five or six days, with the reaction being strongest on the second or third day. However, the effect depends on the puncture site and the amount of poison, so the reaction can be very different. With a wasp sting, for example, the pain can subside after a few minutes, but it can also last for several hours.

The poison from bees and wasps , but also from hornets and bumblebees, is only life-threatening after several hundred stings. This can by rhabdomyolysis , hemolysis , bleeding disorders and platelet deficiency result in life-threatening conditions and acute liver and kidney failure. In the case of allergy sufferers, on the other hand, a single bite can lead to life-threatening reactions. A significant general allergic reaction, which can be potentially life-threatening, can be estimated in around 0.4 to 0.8% of children and around 3% of adults.

Allergic reaction

Swelling and redness on the inside of the thigh two days after a wasp sting
Swelling and redness of the face after bee stings on the head

If the person concerned is sensitized by previous bites ( insect venom allergy ), an allergic ( anaphylactic ) reaction can be triggered by the venom from a single bite . The spectrum ranges from a locally limited skin reaction (redness, swelling, wheals ) to slight general reactions (nausea, headache, extensive skin reactions) and dyspnoea to life-threatening anaphylactic shock . An anaphylactic reaction can occur very quickly. Allergic reactions occur 10 minutes to 5 hours after the bite, but almost always within the first hour.

Diagnosis

Insect-specific IgE antibodies can be detected in the patient's blood . However, these can already be detected when people have been stung by the insect in question at some point. A two-stage antibody determination can allow conclusions to be drawn about the responsible insect due to a possible increase in titer . A differential diagnosis between bees and wasps is also possible using modern molecular IgE allergy diagnostics. The basophil stimulation test can also be used to clarify a questionable anaphylaxis after a bee or wasp sting .

treatment

The first measure in the case of bee stings is the immediate removal of the sting and immediate cooling.

In allergic reaction, a treatment with the appropriate medication (is antihistamines , corticosteroids , epinephrine ) necessary at a distinct anaphylaxis as emergency medical treatment. People at risk can carry an emergency kit, especially a pre-filled adrenaline syringe, with them. The risk can be permanently reduced through immunotherapy , which, however, lasts three to five years. The risk of sting can be reduced by taking precautionary measures. This includes refraining from aggressive movements and avoiding flowers, windfalls, sweet drinks, meadows and the like. a.

  • Bee sting. The stinger gets stuck in the skin.

  • Sting at the sting point

  • After removing the sting

Individual evidence

  1. ↑ Ulrich Wahn: Pediatric Allergology and Immunology.
  2. ↑ Emmanuel A. Burdmann, Vivekanand Jha, Visith Sitprija: Acute Kidney Injury in the Tropics. In: Jürgen Floege, Richard J Johnson, John Feehally: Comprehensive Clinical Nephrology. 4th edition. St. Louis 2010, p. 814.
  3. ^ John E. Moffitt et al. (Joint Task Force on Practice Parameters for Allergy and Immunology): Stinging insect hypersensitivity: A practice parameter update 2011. In: Journal of Allergy and Clinical Immunology . Volume 127, Issue 4, 2011, pp. 852-854.
  4. ↑ a b D. B. Golden: Insect sting anaphylaxis. In: Immunol Allergy Clin North Am . 27 (2), May 2007, pp. 261-272, vii. Review. PMID 17493502 .
  5. ↑ James H. Diaz: Hymenopterid Bites, Stings, Allergic Reactions, and the Impact of Hurricanes on Hymenopterid-Inflicted Injuries. In: Journal of the Louisiana State Medical Society. 159, 2007, pp. 149-157.
  6. ↑ LADR informs: Insect venom allergy
  7. ↑ LADR : Insect venom allergy: most common cause of anaphylactic reactions
  8. ↑ LADR informs: Basophil stimulation test - New possibilities in allergy diagnostics
  9. ^ PK Visscher, RS Vetter, S. Camazine: Removing bee stings. In: Lancet. 348 (9023), Aug 3, 1996, pp. 301-302. PMID 8709689 .
  10. ↑ P. Altmeyer: The online encyclopedia of dermatology, venereology, allergology and environmental medicine, keyword insect sting; enzyklopaedie-dermatologie.de , accessed September 1, 2016.

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