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decision pointShould I have allergy shots for allergies to insect stings?

Your decision about having allergy shots (immunotherapy) for allergies to insect stings will involve several issues regarding your current health and the likelihood that you might develop severe reactions to stings in the future. If your child is allergic to insect stings, these same factors will affect the decision about having allergy shots. Consider the following when making your decision:

  • If you have been stung in the past and had a systemic (whole-body) allergic reaction to the sting, you have a high risk of having a similar reaction if stung again.
  • If you had an anaphylactic (life-threatening) reaction in the past, immunotherapy significantly reduces your risk of having another severe systemic reaction from 60% to 3%.1
  • You may not need allergy shots if you had a normal (localized) reaction or a large localized allergic reaction to an insect sting in the past. Only about 1% to 10% of people with localized reactions to insect stings progress to a more serious, systemic allergic reaction.2
  • If you have taken allergy tests that identified one or more sensitivities to insect stings, immunotherapy can prevent life-threatening reactions and also reduce anxiety associated with insect stings.
  • Allergy shots may not be safe for you if you have an impaired immune system or certain kinds of heart problems.
  • Allergy shots are uncomfortable and costly, may trigger anaphylaxis in some people, and usually take 3 to 5 years to complete.

What are allergies to insect stings?

An allergic reaction to a sting occurs when your body's immune system overreacts to substances called allergens in the venom of stinging insects such as bees, wasps, hornets, or fire ants.

What is a systemic allergic reaction?

Minor allergic reactions occur around the site of the sting (localized reaction) and can cause redness, swelling, fatigue, nausea, and a low fever. A more serious allergic reaction can spread throughout your entire body (systemic reaction) and cause symptoms such as itching, hives, and swelling of the tongue, throat, or other body parts. A life-threatening systemic allergic reaction called anaphylaxis can cause severe symptoms such as confusion, difficulty breathing, shock, and sometimes death.

What is immunotherapy for allergies to insect stings?

Standard immunotherapy is a series of allergy shots that can prevent or reduce the severity of symptoms during a systemic allergic reaction. Allergy shots are not needed if you have mild, local allergic reactions to insect stings.

Allergy shots work by introducing small amounts of insect venom into your body, making you less sensitive over time to the venom.

Once allergy tests have identified the insect(s) you are allergic to, you can begin immunotherapy. At first, you will receive weekly shots containing small doses of venom and allergens from the insect(s) that cause your allergies. After about 4 to 6 months of weekly shots, you will receive a maintenance dose every 4 weeks for another 4 to 6 months. Finally, you will continue getting monthly shots for 3 to 5 years, depending on the type of stings that cause your allergies; for example, fire ant allergies require longer treatment than other stinging insect allergies.

What is rush immunotherapy?

Accelerated or "rush" immunotherapy is done to rapidly increase your tolerance to an allergen. A series of shots is usually given every few hours on the same day or every few days. When the first injection is given, you must wait a period of time to see whether you have a reaction to the shot. If you do not, additional shots are given throughout the day. You (or your child) may have some anxiety about receiving the next injection; it may be helpful to bring a book or something to distract yourself while you wait for the next shot.

Maintenance is reached much more quickly with rush immunotherapy than standard immunotherapy-usually in 1 to 8 days instead of several months. Rush immunotherapy may be given if you have severe or life-threatening allergic reactions to insect stings, are a long distance from any type of health care facility, have severe allergic asthma, or are about to travel.

What are the risks of immunotherapy for allergies to insect stings?

Allergy shots are safe for most people. The most common side effects are redness and warmth at the injection site. Some people may experience large local reactions that include itching, hives, or swelling of the skin near the injection site.

However, allergy shots can trigger a more serious systemic reaction, which may include difficulty breathing or swelling in the deep layers of the skin. On rare occasions, a person may have a life-threatening allergic reaction (anaphylaxis) to the shots. Because of this possibility, the shots are given in a health care facility or other setting where emergency care can be provided if needed.

Talk with your health professional if you have an autoimmune disease (such as lupus) or are taking medications for heart problems (such as beta-blockers); allergy shots may not be safe for you.

If you need more information, see the topic Allergies to Insect Stings.

Your choices are:

  • Get allergy shots to reduce your sensitivity to insect stings and reduce the risk of a severe allergic reaction (anaphylaxis).
  • Do not get allergy shots, and use other measures such as avoiding stinging insects and carrying an allergy kit to deal with the risk of a severe allergic reaction. Allergy shots usually are recommended only for people who have previously had a systemic reaction.

The decision about whether you or your child should have allergy shots (immunotherapy) for insect sting allergies takes into account your personal feelings and the medical facts.

Deciding about allergy shots
Reasons to have allergy shots Reasons to not have allergy shots
  • You tested positive for sensitivity to allergens from the venom of one or more insects.
  • You had a moderate to severe systemic allergic reaction (anaphylaxis) to an insect sting.
  • You work outdoors and have had increasingly worse reactions to each insect sting.
  • You were stung only once by an insect, but you had a moderate to severe reaction.
  • You have systemic reactions to insect stings but cannot carry an allergy kit with you at all times.
  • You won't use an allergy kit (you are hesitant to give yourself an injection).
  • You want to feel less worried or anxious about being stung.

Are there other reasons you might want to have allergy shots?

  • You tested negative for sensitivity to allergens from the venom of insects.
  • Your allergic reaction to insect stings is local or is a large local reaction but not systemic.
  • You are younger than 16 and you had a mild skin reaction all over your body (systemic reaction) without any other symptoms.
  • You are more afraid of the shots than of your reaction to the insect stings and would rather carry an allergy kit with you.
  • You have an autoimmune disease (such as lupus) or are taking heart medications (such as beta-blockers or ACE inhibitors).
  • You attempted allergy shots previously, but the shots triggered a moderate to severe allergic reaction.
  • You do not want to dedicate the time to or pay the expense of having allergy shots.

Are there other reasons you might not want to have allergy shots?

These personal stories may help you make your decision.

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about having allergy shots. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

My allergic reactions to insect stings are usually mild. Yes No Unsure
My allergic reactions to insect stings affect my entire leg or arm or the area where I've been stung. Yes No Unsure
My allergic reactions to insect stings spread to areas other than where I have been stung (systemic reaction). Yes No Unsure
I've had hives, swelling in my face or feet, and difficulty breathing with previous insect stings. Yes No Unsure
I have an autoimmune disease (such as lupus or MS) or I'm taking medications for my heart (such as beta-blockers). Yes No Unsure
I was only stung once by a particular insect but had a pretty severe reaction (anaphylaxis). Yes No NA*
I work outdoors or am outdoors a large part of most days. Yes No NA
I am able to carry my allergy kit wherever I go. Yes No NA
I have explained to all of my coworkers (or my child's day care and school) how to help if I (or my child) have a severe allergic reaction to an insect sting. Yes No NA

*NA=Not applicable

Use the following space to list any other important concerns you have about this decision.

 

 

 

 

 

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to use or not use allergy shots for allergies to insect stings.

Check the box below that represents your overall impression about your decision.

Leaning toward having immunotherapy (allergy shots)

 

Leaning toward NOT having immunotherapy (allergy shots)

         
  • Allergic Reaction.
  • Allergies to Insect Stings.

Citations

  1. Moffitt JE, et al. (2004). Stinging insect hypersensitivity: A practice parameter update. Journal of Allergy and Clinical Immunology, 114(4): 869–886.

  2. Golden DB (2003). Stinging insect allergy. In NF Adkinson Jr et al., eds., Middleton's Allergy Principles and Practice, 6th ed., vol. 2, pp. 1475–1486. Philadelphia: Mosby.

Associate Editor Tracy Landauer
Primary Medical Reviewer William M. Green, MD - Emergency Medicine
Specialist Medical Reviewer Harold S. Nelson, MD - Allergy and Immunology
Last Updated January 13, 2010

WebMD Medical Reference from Healthwise

Last Updated: January 13, 2010
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.

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