ED management of insect stings

Allergic reactions to insect stings are a common and sometimes serious medical problem. Although most reactions to stinging insects are mild, a pool of individuals in the general population has experienced or will manifest an anaphylactic reaction to stings. Concern has been heightened with the introduction of stinging species not indigenous to the United States which have a proclivity for stinging frequently. The emergency physician needs to understand the pathophysiology of insect sting anaphylaxis, recognize its onset, and formulate an appropriate pharmacological treatment plan. In addition, the emergency physician must instruct the patient on avoidance of insects and on outpatient use of epinephrine. For the patient who truly has had an anaphylactic event, referral to an allergist is imperative.