Freeman TM: Hypersensitivity to hymenoptera stings. N Engl J Med 2004;351(19):1978-84.
Stings from fire ants, bees, hornets, wasps, and yellow jackets can lead to serious consequences. Local reactions to hymenoptera stings can be treated with nonsteroidal anti-inflammatory agents, antihistamines, and cold compresses. Epinephrine by injection is the definitive therapy for anaphylaxis. Failure or delay in administering epinephrine to any patient who has more than a cutaneous reaction increases the chance of fatal outcome in anaphylaxis. After a sting, the future risk of anaphylactic reactions ranges from 3% in the general population to 10% in adults with a large local reaction, and up to 50% to 60% in adults or children with previous anaphylaxis. Any patient who has had an anaphylactic reaction to a hymenoptera sting should be provided information on avoidance, be advised to wear a medic alert bracelet, and be prescribed an epinephrine auto-injector. Patients with a clear history of anaphylaxis should be referred to an allergist, since the potential risk of anaphylaxis is reduced to 2% in those receiving immunotherapy.