Preventing and Managing Insect Stings

Effectively managing your sensitivity to insect stings can mean the difference between enjoying the great outdoors relatively worry-free and risking recurrences of serious allergic reactions.

The first step you can take to effectively manage your sensitivity to insect stings (and this should come as no great surprise!) is to avoid getting stung. When it comes to insect stings, an ounce of avoidance is worth a pound of medication.

If you have insect sting hypersensitivity, consult your doctor about taking preventive measures, such as the following:

• Avoid bugging insects, and they usually won't bug you. If stinging insects are in your vicinity, don't provoke them, but move as quickly and calmly out of the area as possible. If you run, flap your arms, or otherwise get agitated, the insect may sting in self-defense. In general, avoid jerky, fast movements, because these can startle and provoke stinging insects.

• Make sure that your children don't poke, prod, hit, or otherwise play with insect hives, nests, or mounds.

• Hire an extermination professional to check your home and its surroundings for insect nests. (This is one home improvement project you don't want to tackle yourself.)

• Stay away from strongly scented lotions, perfumes, colognes, and hair products. Likewise, don't wear brightly colored or flower-print clothing. Try khaki and other light-colored apparel. Also, avoid loose clothing that may trap insects.

• Don't use electric hedge clippers and power mowers. For some reason, electricity really excites Hymenoptera insects, and you don't want to be part of their excitement. If you have a stinging insect hypersensitivity, seriously consider hiring out your yard work.

• If you work outdoors, cover up from head to toe with long pants, a long-sleeved shirt, socks, a hat, and work gloves. Wear closed shoes (not sandals) or sneakers when you're outdoors, and don't go out in your stocking feet or barefoot.

• Practice caution near flowery plants, blooming orchards (they're in bloom because something's busy pollinating them), bushes, clover fields, eaves, attics, garbage containers, and picnic areas.

• Have insecticides at hand to zap stinging insects before they zap you (insect repellents don't work on stinging insects). Bear in mind that if these products kill insects, then they're also not too good for you either. Therefore, make sure that you use insecticides properly as per the manufacturer's instructions, to limit your exposure to the toxins in these products.

• Be careful when eating or drinking outdoors or when you're near areas where food and beverages are served. Also, cover the opening to your beverage in between sips, and never drink from an open container that's been left outdoors.

• Check to see if the insect left a stinger, which usually looks like a black thorn or splinter, in your skin. Carefully remove the stinger, using tweezers to pry or a credit card to flick or scrape the stinger from your skin (certainly the least expensive way to use a credit card!). Never squeeze the stinger with your fingers in an effort to remove it from your skin. Doing so only pumps more venom into your body, making your reaction worse.

• After a sting, walk slowly, don't run. Running may increase your body's absorption of the venom.

Treating local reactions

You can manage the symptoms of local reactions (itching, swelling, and pain) until they pass with simple remedies, such as:

• Cold compresses, which can help reduce local pain and swelling.

• Local anesthetic cream, oral antihistamines, and oral analgesics, which may help relieve the pain and itching of skin reactions.

Responding to systemic reactions

Hives and angioedema (deep swellings) can sometimes be the first signs of an impending anaphylactic insect sting reaction. Because it's impossible to predict whether these systemic symptoms will or will not progress to anaphylaxis, it's therefore safer to immediately administer epinephrine than to wait until the reaction potentially becomes life threatening.

If the systemic reaction is limited to hives and angioedema, then your best strategy is to avoid further aggravating your skin while soothing it as much as possible. Advisable steps include

• Bathing and washing with lukewarm water and using gentle soaps instead of harsh ones to reduce itching. Hot baths and showers may intensify your symptoms. Likewise, avoid hot environments and keep your home — especially your bedroom — cool.

• Patting your skin dry with a soft towel after bathing and applying moisturizers immediately afterward to seal in moisture.

• Wearing comfortable, loose, cotton clothing instead of tight-fitting garments.

• Taking oral antihistamines may also be advisable to help relieve your symptoms.

Handling urgent insect sting cases

If you're prone to serious systemic insect-sting reactions, and you get stung despite taking protective measures, you should be prepared to prevent a life-threatening reaction (anaphylaxis). Consult with your doctor about getting a prescription for an injectable-epinephrine kit (such as an EpiPen, EpiPen Jr. for children under 66 pounds, or AnaKit), which contains an injectable dose of epinephrine.

Make sure that your doctor shows you how to use the epinephrine kit. Learning the proper technique for administering epinephrine in your physician's office is much better than to trying to figure it out for the first time when you're having a reaction.

Keep these important points about using an epinephrine kit in mind:

• Have more than one injectable-epinephrine kit. This way, you can keep one at home and have one with you when you may be exposed to stinging insects, for example during a picnic, while hiking, or during other outdoor activities. You may want to keep more than one kit with you when traveling or going on an extended outing, because the initial injection wears off in 30 minutes and you may need another injection before you can get emergency care.

• Store any kits you're not keeping with you at room temperature, and protect them from sunlight.

• If your child is at risk for anaphylactic reactions to insect stings, keep a kit at home and consider keeping one at his or her school or day care (in consultation with the personnel at these places). Make sure personnel at those locations know how and when to administer this medication.

• In addition to the injectable-epinephrine kit, keep an antihistamine such as diphenhydramine (Benadryl) with you in the event of a serious insect sting reaction. However, don't rely solely on an antihistamine, which can take up to 30 minutes to start becoming effective. In addition, this medication will not prevent anaphylaxis. Clearly, injectable epinephrine should be the initial treatment for anaphylaxis before using any antihistamine.

• Remember that you need to get emergency treatment immediately after using your epinephrine kit, because the drug's effect usually doesn't last more than 30 minutes.

If you're at risk for anaphylaxis, wear a Medic Alert bracelet or necklace in case you're unable to speak during a reaction.

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