Hymenoptera stings - Revision history

Elcatracho: /* Fire Ants (Formicidae) */

2021-02-08T23:33:31Z

Fire Ants (Formicidae)

← Revisión anterior		Revisión del 23:33 8 feb 2021
Línea 20:		Línea 20:
	===Fire Ants (Formicidae)===		===Fire Ants (Formicidae)===
	[[File:Fire ants 01.jpg\|thumb\|Fire ants]]		[[File:Fire ants 01.jpg\|thumb\|Fire ants]]
			*''Solenopsis invicta'' (red fire ant) and ''Solenopsis richteri'' (black fire ant)
	*Alkaloid venom		*Alkaloid venom
	*Intense burning papules that may turn to pustules in 24hrs		*Intense burning papules that may turn to pustules in 24hrs

ClaireLewis at 19:16, 28 September 2019

2019-09-28T19:16:35Z

← Revisión anterior		Revisión del 19:16 28 sep 2019
Línea 16:		Línea 16:
	*Non barbed stinger - can sting multiple times and the sting does not cause the wasps' death		*Non barbed stinger - can sting multiple times and the sting does not cause the wasps' death
	*Histamine, phospholipase, antigen 5, and bradykinin similar to bees<ref name="King"></ref>		*Histamine, phospholipase, antigen 5, and bradykinin similar to bees<ref name="King"></ref>
	*~~redness~~ and irritation last 1-3 days		*Redness and irritation last 1-3 days

	===Fire Ants (Formicidae)===		===Fire Ants (Formicidae)===
Línea 31:		Línea 31:
	[[File:Bee sting 5.jpg\|thumb\|Local reaction: 1 day after bee sting]]		[[File:Bee sting 5.jpg\|thumb\|Local reaction: 1 day after bee sting]]
	[[File:FireAntBite.jpg\|thumb\|Local reaction: Fire ant bite]]		[[File:FireAntBite.jpg\|thumb\|Local reaction: Fire ant bite]]
	*Urticarial lesion contiguous with sting site		*[[urticaria\|Urticarial]] lesion contiguous with sting site
	*Severe local reaction may involve one or more neighboring joints		*Severe local reaction may involve one or more neighboring joints
	*Local reaction occurring in mouth or throat can produce airway obstruction		*Local reaction occurring in mouth or throat can produce airway obstruction
	*Local reaction occurring around eye can result in cataract, iris atrophy, globe ~~perf~~		*Local reaction occurring around eye can result in cataract, iris atrophy, [[globe rupture\|globe perforation]]

	===Toxic Reaction===		===Toxic Reaction===
Línea 40:		Línea 40:
	*May be delayed 8-24hrs		*May be delayed 8-24hrs
	*Venom mediated, not IgE		*Venom mediated, not IgE
	*Resembles anaphylaxis but greater frequency of nausea/vomiting and diarrhea		*Resembles [[anaphylaxis]] but greater frequency of [[nausea/vomiting]] and [[diarrhea]]
	**Other symptoms: light-headedness, syncope, headache, fever, drowsiness, muscle spasms		**Other symptoms: [[dizziness\|light-headedness]], [[syncope]], [[headache]], [[fever]], [[fatigue\|drowsiness]], muscle spasms
	*Massive stings can result in renal or hepatic failure, DIC, rhabdo		*Massive stings can result in [[renal failure\|renal]] or [[hepatic failure]], [[DIC]], [[rhabdo]]
	*Systemic toxicity more likely if > 50 stings		*Systemic toxicity more likely if > 50 stings
	*Median lethal dose of honeybee venom ~19 stings/kg or 500-1400 stings per human		*Median lethal dose of honeybee venom ~19 stings/kg or 500-1400 stings per human
Línea 54:		Línea 54:
	===Delayed Reaction===		===Delayed Reaction===
	*May occur 5-14d after a sting		*May occur 5-14d after a sting
	*Serum-sickness features (fever, malaise, urticaria, lymphadenopathy, polyarthritis)		*[[Serum sickness]] features (fever, malaise, urticaria, lymphadenopathy, polyarthritis)

	==Differential Diagnosis==		==Differential Diagnosis==
Línea 65:		Línea 65:
	*Stinger Removal		*Stinger Removal
	**Immediate removal is the most important principle; the method of removal is irrelevant		**Immediate removal is the most important principle; the method of removal is irrelevant
	*Local wound care and tetanus prophylaxis		*Local wound care and [[tetanus prophylaxis]]
	*Oral [[Antihistamines]] provide symptom relief for pruritus		*Oral [[Antihistamines]] provide symptom relief for [[pruritus]]

	===Local Reaction===		===Local Reaction===
	*Ice packs diminish swelling and delays absorption of venom		*Ice packs diminish swelling and delays absorption of venom
	*NSAIDs and antihistamines for comfort		*[[NSAIDs]] and [[antihistamines]] for comfort
	*Infection is uncommon, but may present as ongoing swelling or cellulitis		*Infection is uncommon, but may present as ongoing swelling or [[cellulitis]]

	===Systemic reaction===		===Systemic reaction===

Adriack: /* Disposition */

2017-09-05T18:02:06Z

Disposition

← Revisión anterior		Revisión del 18:02 5 sep 2017
Línea 79:		Línea 79:
	*Normally outpatient, unless [[anaphylaxis]] or systemic toxicity		*Normally outpatient, unless [[anaphylaxis]] or systemic toxicity
	**EpiPen should be prescribed on discharge if significant reaction		**EpiPen should be prescribed on discharge if significant reaction
			*Admission/observation for victims with >100 stings, substantial comorbidities, those at extremes of age

	==See Also==		==See Also==

Adriack: /* Local Reaction */

2017-09-05T17:56:56Z

Local Reaction

← Revisión anterior		Revisión del 17:56 5 sep 2017
Línea 32:		Línea 32:
	[[File:FireAntBite.jpg\|thumb\|Local reaction: Fire ant bite]]		[[File:FireAntBite.jpg\|thumb\|Local reaction: Fire ant bite]]
	*Urticarial lesion contiguous with sting site		*Urticarial lesion contiguous with sting site
			*Severe local reaction may involve one or more neighboring joints
	*Local reaction occurring in mouth or throat can produce airway obstruction		*Local reaction occurring in mouth or throat can produce airway obstruction
	*Local reaction occurring around eye can result in cataract, iris atrophy, globe perf		*Local reaction occurring around eye can result in cataract, iris atrophy, globe perf

Mholtz: Text replacement - "Epinephine" to "Epinephrine"

2017-05-25T14:55:46Z

Text replacement - "Epinephine" to "Epinephrine"

← Revisión anterior		Revisión del 14:55 25 may 2017
Línea 92:		Línea 92:
	-the size of the bee’s stinger		-the size of the bee’s stinger
	+the nature of the most severe previous reaction experienced by the patient		+the nature of the most severe previous reaction experienced by the patient
	\|\|Freeman TM. Hypersensitivity to Hymenoptera stings. N Engl J Med 2004; 351: 1978-1984. The risk of anaphylaxis with any event is dependent on the nature of the most severe previous reaction experienced by a patient Local reactions are best treated symptomatically with nonsteroidal antiinflammatory agents, antihistamines, and cold compresses. The definitive therapy for anaphylaxis is epinephrine by injection (0.01mg per kilogram of body weight; maximum, 0.3 and 0.5mg per dose, for children and adults, respectively), and this should be administered to any patient who has more than a cutaneous reaction. Antihistamines are often added to treat cutaneous signs and symptoms. Supplemental oxygen, beta-agonists for bronchospasm, and intravenous fluids for hypotension are sometimes indicated. Occasionally, for a reaction that does not respond to the initial dose of epinephrine, steroids (oral or intravenous) are added, although definitive support for their addition is lacking. [[~~Epinephine~~]]auto-injectors should be prescribed for any patient who has had an anaphylactic reaction to a hymenoptera sting. The instructions for use are printed on the side of each injector, but these should be reviewed with the patient when prescribing the medication. Patients should be educated to use epinephrine if signs or symptoms beyond a cutaneous reaction develop after a hymenoptera sting, and always to seek additional medical care after using an injector. Patients should also be advised to wear a medical alert bracelet. Referral to an allergist is warranted, and skin testing should be performed for sensitivity to honeybees, wasps, white-faced hornets, yellow hornets, and yellow jackets. Venom immunotherapy should be administered for all venoms for which testing results are positive. The protective benefit is expected from the immunotherapy by the time maintenance dose is reached, usually by three to six months with standard protocols.		\|\|Freeman TM. Hypersensitivity to Hymenoptera stings. N Engl J Med 2004; 351: 1978-1984. The risk of anaphylaxis with any event is dependent on the nature of the most severe previous reaction experienced by a patient Local reactions are best treated symptomatically with nonsteroidal antiinflammatory agents, antihistamines, and cold compresses. The definitive therapy for anaphylaxis is epinephrine by injection (0.01mg per kilogram of body weight; maximum, 0.3 and 0.5mg per dose, for children and adults, respectively), and this should be administered to any patient who has more than a cutaneous reaction. Antihistamines are often added to treat cutaneous signs and symptoms. Supplemental oxygen, beta-agonists for bronchospasm, and intravenous fluids for hypotension are sometimes indicated. Occasionally, for a reaction that does not respond to the initial dose of epinephrine, steroids (oral or intravenous) are added, although definitive support for their addition is lacking. [[Epinephrine]]auto-injectors should be prescribed for any patient who has had an anaphylactic reaction to a hymenoptera sting. The instructions for use are printed on the side of each injector, but these should be reviewed with the patient when prescribing the medication. Patients should be educated to use epinephrine if signs or symptoms beyond a cutaneous reaction develop after a hymenoptera sting, and always to seek additional medical care after using an injector. Patients should also be advised to wear a medical alert bracelet. Referral to an allergist is warranted, and skin testing should be performed for sensitivity to honeybees, wasps, white-faced hornets, yellow hornets, and yellow jackets. Venom immunotherapy should be administered for all venoms for which testing results are positive. The protective benefit is expected from the immunotherapy by the time maintenance dose is reached, usually by three to six months with standard protocols.
	-the amount of cutaneous erythema		-the amount of cutaneous erythema
	-whether the patient is on oral steroid treatment		-whether the patient is on oral steroid treatment

Ostermayer: Text replacement - "Anaphylaxis " to "Anaphylaxis "

2017-03-10T13:53:34Z

Text replacement - "Anaphylaxis " to "Anaphylaxis "

← Revisión anterior		Revisión del 13:53 10 mar 2017
Línea 22:		Línea 22:
	*Alkaloid venom		*Alkaloid venom
	*Intense burning papules that may turn to pustules in 24hrs		*Intense burning papules that may turn to pustules in 24hrs
	*Localized necrosis has also been reported<ref>Fernández-Meléndez S. et al. Anaphylaxis caused by imported red fire ant stings in Málaga, Spain. J Investig Allergol Immunol. 2007;17(1):48-49</ref>		*Localized necrosis has also been reported<ref>Fernández-Meléndez S. et al. [[Anaphylaxis]] caused by imported red fire ant stings in Málaga, Spain. J Investig Allergol Immunol. 2007;17(1):48-49</ref>

	==Clinical Features==		==Clinical Features==

Ostermayer: Text replacement - "Epinephrine " to "Epinephine"

2017-03-10T12:47:50Z

Text replacement - "Epinephrine " to "Epinephine"

← Revisión anterior		Revisión del 12:47 10 mar 2017
Línea 92:		Línea 92:
	-the size of the bee’s stinger		-the size of the bee’s stinger
	+the nature of the most severe previous reaction experienced by the patient		+the nature of the most severe previous reaction experienced by the patient
	\|\|Freeman TM. Hypersensitivity to Hymenoptera stings. N Engl J Med 2004; 351: 1978-1984. The risk of anaphylaxis with any event is dependent on the nature of the most severe previous reaction experienced by a patient Local reactions are best treated symptomatically with nonsteroidal antiinflammatory agents, antihistamines, and cold compresses. The definitive therapy for anaphylaxis is epinephrine by injection (0.01mg per kilogram of body weight; maximum, 0.3 and 0.5mg per dose, for children and adults, respectively), and this should be administered to any patient who has more than a cutaneous reaction. Antihistamines are often added to treat cutaneous signs and symptoms. Supplemental oxygen, beta-agonists for bronchospasm, and intravenous fluids for hypotension are sometimes indicated. Occasionally, for a reaction that does not respond to the initial dose of epinephrine, steroids (oral or intravenous) are added, although definitive support for their addition is lacking. ~~Epinephrine~~ auto-injectors should be prescribed for any patient who has had an anaphylactic reaction to a hymenoptera sting. The instructions for use are printed on the side of each injector, but these should be reviewed with the patient when prescribing the medication. Patients should be educated to use epinephrine if signs or symptoms beyond a cutaneous reaction develop after a hymenoptera sting, and always to seek additional medical care after using an injector. Patients should also be advised to wear a medical alert bracelet. Referral to an allergist is warranted, and skin testing should be performed for sensitivity to honeybees, wasps, white-faced hornets, yellow hornets, and yellow jackets. Venom immunotherapy should be administered for all venoms for which testing results are positive. The protective benefit is expected from the immunotherapy by the time maintenance dose is reached, usually by three to six months with standard protocols.		\|\|Freeman TM. Hypersensitivity to Hymenoptera stings. N Engl J Med 2004; 351: 1978-1984. The risk of anaphylaxis with any event is dependent on the nature of the most severe previous reaction experienced by a patient Local reactions are best treated symptomatically with nonsteroidal antiinflammatory agents, antihistamines, and cold compresses. The definitive therapy for anaphylaxis is epinephrine by injection (0.01mg per kilogram of body weight; maximum, 0.3 and 0.5mg per dose, for children and adults, respectively), and this should be administered to any patient who has more than a cutaneous reaction. Antihistamines are often added to treat cutaneous signs and symptoms. Supplemental oxygen, beta-agonists for bronchospasm, and intravenous fluids for hypotension are sometimes indicated. Occasionally, for a reaction that does not respond to the initial dose of epinephrine, steroids (oral or intravenous) are added, although definitive support for their addition is lacking. [[Epinephine]]auto-injectors should be prescribed for any patient who has had an anaphylactic reaction to a hymenoptera sting. The instructions for use are printed on the side of each injector, but these should be reviewed with the patient when prescribing the medication. Patients should be educated to use epinephrine if signs or symptoms beyond a cutaneous reaction develop after a hymenoptera sting, and always to seek additional medical care after using an injector. Patients should also be advised to wear a medical alert bracelet. Referral to an allergist is warranted, and skin testing should be performed for sensitivity to honeybees, wasps, white-faced hornets, yellow hornets, and yellow jackets. Venom immunotherapy should be administered for all venoms for which testing results are positive. The protective benefit is expected from the immunotherapy by the time maintenance dose is reached, usually by three to six months with standard protocols.
	-the amount of cutaneous erythema		-the amount of cutaneous erythema
	-whether the patient is on oral steroid treatment		-whether the patient is on oral steroid treatment

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-24T03:46:36Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Revisión anterior		Revisión del 03:46 24 jul 2016
Línea 58:		Línea 58:
	{{Bites and stings DDX}}		{{Bites and stings DDX}}

	==~~Diagnosis~~==		==Evaluation==
	*Usually clinical		*Usually clinical

Neil.m.young: Text replacement - "5 mg" to "5mg"

2016-07-19T10:19:58Z

Text replacement - "5 mg" to "5mg"

← Revisión anterior		Revisión del 10:19 19 jul 2016
Línea 92:		Línea 92:
	-the size of the bee’s stinger		-the size of the bee’s stinger
	+the nature of the most severe previous reaction experienced by the patient		+the nature of the most severe previous reaction experienced by the patient
	\|\|Freeman TM. Hypersensitivity to Hymenoptera stings. N Engl J Med 2004; 351: 1978-1984. The risk of anaphylaxis with any event is dependent on the nature of the most severe previous reaction experienced by a patient Local reactions are best treated symptomatically with nonsteroidal antiinflammatory agents, antihistamines, and cold compresses. The definitive therapy for anaphylaxis is epinephrine by injection (0.01mg per kilogram of body weight; maximum, 0.3 and 0.~~5 mg~~ per dose, for children and adults, respectively), and this should be administered to any patient who has more than a cutaneous reaction. Antihistamines are often added to treat cutaneous signs and symptoms. Supplemental oxygen, beta-agonists for bronchospasm, and intravenous fluids for hypotension are sometimes indicated. Occasionally, for a reaction that does not respond to the initial dose of epinephrine, steroids (oral or intravenous) are added, although definitive support for their addition is lacking. Epinephrine auto-injectors should be prescribed for any patient who has had an anaphylactic reaction to a hymenoptera sting. The instructions for use are printed on the side of each injector, but these should be reviewed with the patient when prescribing the medication. Patients should be educated to use epinephrine if signs or symptoms beyond a cutaneous reaction develop after a hymenoptera sting, and always to seek additional medical care after using an injector. Patients should also be advised to wear a medical alert bracelet. Referral to an allergist is warranted, and skin testing should be performed for sensitivity to honeybees, wasps, white-faced hornets, yellow hornets, and yellow jackets. Venom immunotherapy should be administered for all venoms for which testing results are positive. The protective benefit is expected from the immunotherapy by the time maintenance dose is reached, usually by three to six months with standard protocols.		\|\|Freeman TM. Hypersensitivity to Hymenoptera stings. N Engl J Med 2004; 351: 1978-1984. The risk of anaphylaxis with any event is dependent on the nature of the most severe previous reaction experienced by a patient Local reactions are best treated symptomatically with nonsteroidal antiinflammatory agents, antihistamines, and cold compresses. The definitive therapy for anaphylaxis is epinephrine by injection (0.01mg per kilogram of body weight; maximum, 0.3 and 0.5mg per dose, for children and adults, respectively), and this should be administered to any patient who has more than a cutaneous reaction. Antihistamines are often added to treat cutaneous signs and symptoms. Supplemental oxygen, beta-agonists for bronchospasm, and intravenous fluids for hypotension are sometimes indicated. Occasionally, for a reaction that does not respond to the initial dose of epinephrine, steroids (oral or intravenous) are added, although definitive support for their addition is lacking. Epinephrine auto-injectors should be prescribed for any patient who has had an anaphylactic reaction to a hymenoptera sting. The instructions for use are printed on the side of each injector, but these should be reviewed with the patient when prescribing the medication. Patients should be educated to use epinephrine if signs or symptoms beyond a cutaneous reaction develop after a hymenoptera sting, and always to seek additional medical care after using an injector. Patients should also be advised to wear a medical alert bracelet. Referral to an allergist is warranted, and skin testing should be performed for sensitivity to honeybees, wasps, white-faced hornets, yellow hornets, and yellow jackets. Venom immunotherapy should be administered for all venoms for which testing results are positive. The protective benefit is expected from the immunotherapy by the time maintenance dose is reached, usually by three to six months with standard protocols.
	-the amount of cutaneous erythema		-the amount of cutaneous erythema
	-whether the patient is on oral steroid treatment		-whether the patient is on oral steroid treatment

Neil.m.young: Text replacement - "1 mg" to "1mg"

2016-07-19T10:15:29Z

Text replacement - "1 mg" to "1mg"

← Revisión anterior		Revisión del 10:15 19 jul 2016
Línea 92:		Línea 92:
	-the size of the bee’s stinger		-the size of the bee’s stinger
	+the nature of the most severe previous reaction experienced by the patient		+the nature of the most severe previous reaction experienced by the patient
	\|\|Freeman TM. Hypersensitivity to Hymenoptera stings. N Engl J Med 2004; 351: 1978-1984. The risk of anaphylaxis with any event is dependent on the nature of the most severe previous reaction experienced by a patient Local reactions are best treated symptomatically with nonsteroidal antiinflammatory agents, antihistamines, and cold compresses. The definitive therapy for anaphylaxis is epinephrine by injection (0.~~01 mg~~ per kilogram of body weight; maximum, 0.3 and 0.5 mg per dose, for children and adults, respectively), and this should be administered to any patient who has more than a cutaneous reaction. Antihistamines are often added to treat cutaneous signs and symptoms. Supplemental oxygen, beta-agonists for bronchospasm, and intravenous fluids for hypotension are sometimes indicated. Occasionally, for a reaction that does not respond to the initial dose of epinephrine, steroids (oral or intravenous) are added, although definitive support for their addition is lacking. Epinephrine auto-injectors should be prescribed for any patient who has had an anaphylactic reaction to a hymenoptera sting. The instructions for use are printed on the side of each injector, but these should be reviewed with the patient when prescribing the medication. Patients should be educated to use epinephrine if signs or symptoms beyond a cutaneous reaction develop after a hymenoptera sting, and always to seek additional medical care after using an injector. Patients should also be advised to wear a medical alert bracelet. Referral to an allergist is warranted, and skin testing should be performed for sensitivity to honeybees, wasps, white-faced hornets, yellow hornets, and yellow jackets. Venom immunotherapy should be administered for all venoms for which testing results are positive. The protective benefit is expected from the immunotherapy by the time maintenance dose is reached, usually by three to six months with standard protocols.		\|\|Freeman TM. Hypersensitivity to Hymenoptera stings. N Engl J Med 2004; 351: 1978-1984. The risk of anaphylaxis with any event is dependent on the nature of the most severe previous reaction experienced by a patient Local reactions are best treated symptomatically with nonsteroidal antiinflammatory agents, antihistamines, and cold compresses. The definitive therapy for anaphylaxis is epinephrine by injection (0.01mg per kilogram of body weight; maximum, 0.3 and 0.5 mg per dose, for children and adults, respectively), and this should be administered to any patient who has more than a cutaneous reaction. Antihistamines are often added to treat cutaneous signs and symptoms. Supplemental oxygen, beta-agonists for bronchospasm, and intravenous fluids for hypotension are sometimes indicated. Occasionally, for a reaction that does not respond to the initial dose of epinephrine, steroids (oral or intravenous) are added, although definitive support for their addition is lacking. Epinephrine auto-injectors should be prescribed for any patient who has had an anaphylactic reaction to a hymenoptera sting. The instructions for use are printed on the side of each injector, but these should be reviewed with the patient when prescribing the medication. Patients should be educated to use epinephrine if signs or symptoms beyond a cutaneous reaction develop after a hymenoptera sting, and always to seek additional medical care after using an injector. Patients should also be advised to wear a medical alert bracelet. Referral to an allergist is warranted, and skin testing should be performed for sensitivity to honeybees, wasps, white-faced hornets, yellow hornets, and yellow jackets. Venom immunotherapy should be administered for all venoms for which testing results are positive. The protective benefit is expected from the immunotherapy by the time maintenance dose is reached, usually by three to six months with standard protocols.
	-the amount of cutaneous erythema		-the amount of cutaneous erythema
	-whether the patient is on oral steroid treatment		-whether the patient is on oral steroid treatment