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Hymenoptera sting allergy

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Updated 2023 DGAKI guidelines for the evaluation and management of Hymenoptera sting allergy.

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of hymenoptera sting allergy are prepared by our editorial team based on guidelines from the American Academy of Allergy, Asthma & Immunology (AAAAI 2024), the German Society for Pediatric Allergology and Environmental Medicine (GPA/DDG/ABD/ÖGAI/DGP/DGAKI/AeDA/DGHNOKHC/DGKJ 2023), the European Academy of Allergy and Clinical Immunology (EAACI 2018,2014), and the American Academy of Allergy, ...
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Screening and diagnosis

Indications for testing: as per ABD/AeDA/DDG/DGAKI/DGHNOKHC/DGKJ/DGP/GPA/ÖGAI 2023 guidelines, obtain allergy testing in patients with a history of a general allergic reaction after a Hymenoptera sting.
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Diagnostic investigations

History and physical examination
As per ABD/AeDA/DDG/DGAKI/DGHNOKHC/DGKJ/DGP/GPA/ÖGAI 2023 guidelines:
Elicit medical history, including risk factors for an increased sting risk and possible risk factors for more severe anaphylaxis.
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Inspect the skin to detect cutaneous mastocytosis in patients with a history of a systemic allergic reaction that affected not only the skin.
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More topics in this section

  • Hypersensitivity skin testing

  • Specific IgE testing

  • Serum tryptase levels

  • Sting provocation testing

Medical management

Management of local reactions: as per ABD/AeDA/DDG/DGAKI/DGHNOKHC/DGKJ/DGP/GPA/ÖGAI 2023 guidelines, consider offering symptomatic acute treatment with non-sedating antihistamines, cooling compresses, and topical and/or systemic corticosteroids.
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  • Management of systemic reactions

  • Epinephrine autoinjectors

  • Venom immunotherapy (indications, adult patients)

  • Venom immunotherapy (indications, pediatric patients)

  • Venom immunotherapy (indications, pregnant patients)

  • Venom immunotherapy (indications, patients with comorbidities)

  • Venom immunotherapy (contraindications)

  • Venom immunotherapy (premedication)

  • Venom immunotherapy (choice of venom preparation)

  • Venom immunotherapy (dosing)

  • Venom immunotherapy (duration)

  • Venom immunotherapy (avoidance of insect stings)

  • Venom immunotherapy (concomitant pharmacotherapy)

  • Venom immunotherapy (epinephrine autoinjectors)

  • Venom immunotherapy (management of side effects)

  • Venom immunotherapy (assessment for treatment response)

Specific circumstances

Patients with fire ant sting allergy: as per AAAAI/ACAAI 2017 guidelines, offer immunotherapy with imported fire ant whole-body extract in all patients with a history of moderate or severe systemic reaction to a fire ant sting and having positive skin test responses or allergen-specific serologic test results with imported fire ant whole-body extract.
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Preventative measures

Avoidance of insect stings: as per AAAAI/ACAAI 2017 guidelines, advise about effective measures to avoid insect stings in patients with a history of systemic reactions to insect stings.
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Follow-up and surveillance

Indications for allergist/immunologist referral: as per AAAAI/ACAAI 2017 guidelines, refer patients with a history of systemic reactions to insect stings for evaluation by an allergist/immunologist, the use of specific IgE testing for stinging insect sensitivity, and the potential advantages of venom immunotherapy.
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Quality improvement

Medical alert accessory: as per AAAAI/ACAAI 2017 guidelines, advise carrying a medical identification accessory in patients with a history of systemic reactions to insect stings.
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