Substance:
Hymenoptera venom
Common name:
Bee, wasp, hornet, stings
Involving system:
Immune system: IgE-mediated hypersensitivity [1].
Cardiovascular system: Hypotension,
anaphylactic shock [2]
Respiratory system: Bronchospasm, airway
edema [3]
Dermatologic system: Urticaria, angioedema,
erythema [4, 5]
Neurological/psychological: Panic, fear,
anxiety—especially pronounced in females [6].
Presentation:
Most stings cause local reactions (pain,
swelling, redness).
Large local reactions (LLRs): >10 cm
swelling over 24–48 hours, typically benign. [7]
Systemic reactions (SRs): Include
generalized urticaria, dyspnea, hypotension, collapse. [5,
8]
Anaphylaxis: Life-threatening; rapid onset
of multisystem involvement.
Gender differences:
Females tend to report more severe subjective symptoms (pain, anxiety), and have higher rates of anxiety and PTSD after stings. A significant percentage of stings in females occurred on holidays (47.8% vs. 26.8%, p = 0.008), and drop in DBP was more noticeable in females (76.3 vs. 70.3 mmHg). [5].
Males are more likely to experience
systemic reactions, possibly due to occupational/environmental exposure (e.g.,
agriculture, outdoor work). Males experiencing significantly more Hymenoptera
stings (1.3 vs. 1.0, p = 0.049) [5]
Males are also less likely to carry
epinephrine autoinjectors and adhere to follow-up, whereas females are more
compliant with allergist visits and venom immunotherapy (VIT) [9].
.
Antidote / Management:
First-line: Intramuscular epinephrine (0.3 mg adult; 0.15 mg pediatric) in SRs [5, 10]
Supportive care: Oxygen, IV fluids,
bronchodilators, corticosteroids, H1/H2 antihistamines [5]
Venom immunotherapy (VIT): Highly effective
long-term desensitization for patients with systemic allergic reactions. [9]
Disposition:
Mild local reactions: Discharge with
symptomatic care (cold compress, antihistamines, NSAIDs)
Anaphylaxis/systemic reactions: Admit or
observe in ED; consider ICU for severe cases
Educate patient and caregivers on sting
avoidance, epinephrine use, and emergency action plan
References
[1] Sturm GJ, Heinemann A, Schuster C,
Wiednig M, Groselj-Strele A, Sturm EM, Aberer W. Influence of total IgE levels
on the severity of sting reactions in Hymenoptera venom allergy. Allergy. 2007
Aug;62(8):884-9. doi: 10.1111/j.1398-9995.2007.01413.x. PMID: 17620065.
[2] van der Linden PW, Struyvenberg A,
Kraaijenhagen RJ, Hack CE, van der Zwan JK. Anaphylactic shock after
insect-sting challenge in 138 persons with a previous insect-sting reaction.
Ann Intern Med. 1993 Feb 1;118(3):161-8. doi: 10.7326/0003-4819-118-3-199302010-00001.
PMID: 8417633.
[3] Mayer DE, Krauskopf A, Hemmer W, Moritz
K, Jarisch R, Reiter C. Usefulness of post mortem determination of serum
tryptase, histamine and diamine oxidase in the diagnosis of fatal anaphylaxis.
Forensic Sci Int. 2011 Oct 10;212(1-3):96-101. doi: 10.1016/j.forsciint.2011.05.020.
Epub 2011 Jun 12. PMID: 21664082.
[4] Colombi S, Cantone R, Massara G,
Parachini F, Petrella V, Pastore M, Galimberti M. Reazioni da imenotteri: un
problema di pronto soccorso [Reactions caused by Hymenoptera: a first aid
problem]. Minerva Med. 1988 Jul;79(7):539-42. Italian. PMID: 3405456.
[5] Yu CH, Tan ST, Yang HW, Lai YC, Su YJ. Gender-Based Clinical Differences in Hymenoptera Venom Poisoning: A Retrospective Study From Taiwan (April 2021 to March 2023). Emerg Med Int. 2025 Jun 2;2025:8893175. doi: 10.1155/emmi/8893175. PMID: 40495953; PMCID: PMC12149513.
[6] Woźniewicz A, Szynkiewicz E, Pałgan K, Graczyk M, Dowbór-Dzwonka A, Bartuzi Z. Fear of stinging insects in relation to state anxiety and trait anxiety in a group of patients with hymenoptera venom allergy undergoing immunotherapy. Postepy Dermatol Alergol. 2019 Aug;36(4):472-477. doi: 10.5114/ada.2018.78808. Epub 2019 Aug 30. PMID: 31616224; PMCID: PMC6791157.
[7] .Bilò MB, Martini M, Pravettoni V, Bignardi D, Bonadonna P, Cortellini G, Kosinska M, Macchia D, Mauro M, Meucci E, Nittner-Marszalska M, Patella V, Pio R, Quercia O, Reccardini F, Ridolo E, Rudenko M, Severino M. Large local reactions to Hymenoptera stings: Outcome of re-stings in real life. Allergy. 2019 Oct;74(10):1969-1976. doi: 10.1111/all.13863. Epub 2019 May 28. PMID: 31074868.
[8].Chang CW, Chen HY, Mao CY, Lin YP, Yang HW, Tan ST, Yu CH, Su YJ. Allergic reactions after Hymenoptera stings in older adults: A multi-center study. Am J Emerg Med. 2025 Apr 25;94:179-184. doi: 10.1016/j.ajem.2025.04.044. Epub ahead of print. PMID: 40318385.
[9].Bilò BM, Bonifazi F. Hymenoptera venom immunotherapy. Immunotherapy. 2011 Feb;3(2):229-46. doi: 10.2217/imt.10.88. PMID: 21322761.
[10]. Sicherer SH, Simons FER; SECTION ON ALLERGY AND IMMUNOLOGY. Epinephrine for First-aid Management of Anaphylaxis. Pediatrics. 2017 Mar;139(3):e20164006. doi: 10.1542/peds.2016-4006. Epub 2017 Feb 13. PMID: 28193791.
Edited by Yu-Jang Su June 20, 2025,
June 21, 2025 revised.