The main treatment options for allergic sting reactions are
- Symptomatic treatment of acute symptoms
- Avoidance of future exposure, and
- Specific immunotherapy (SIT; only for patients with a history of systemic anaphylactic sting reactions, who are sensitized to venom).
Acute reactions are managed by symptomatic therapy. If a systemic sting reaction has occurred, immediate medical intervention is required. Patients with large local reactions may benefit from cool dressings, topical application of corticosteroids, and oral antihistamines. If swelling is large or unfavourably located, the patient should seek medical advice to get relief from pain and swelling. Patients, who previously had a hypersensitivity reaction to a sting, should carry an emergency medication in case of subsequent sting reactions. Type and dose of emergency medication are adapted to the type of previous reactions, and to age, and weight of the patient.
Only in those patients who have previously sustained a systemic reaction, an adrenaline injector for self-administration is part of the emergency kit.
However, stings cannot always be prevented. Therefore, an important treatment option to prevent subsequent systemic sting reactions is specific immunotherapy (SIT) with venom. SIT aims at the induction of an immunologic tolerance to the allergen. SIT is performed by a controlled subcutaneous injection of the culprit allergen in incremental doses (up-dose phase). Dose increase will be performed up to the point at which in case of bee venom allergy, a dose has been reached approximately corresponding to that delivered by a single bee sting, or, in case of wasp venom allergy, to a dose representing the cumulative dose delivered by two or even more wasp stings. After the final venom dose has been reached, treatment is continued for several years (maintenance treatment).
During therapy, common side effects consist in local swelling and itching at the injection site. Systemic allergic reactions are the most important adverse effects of venom SIT, occurring particularly during the incremental phase. Mostly, these reactions are mild, but careful medical control is always necessary during this treatment.