Wasp Stings Medication
- Author: Carl A Mealie, MD, FACEP, FAAEM; Chief Editor: Rick Kulkarni, MD more...
Medication Summary
Medication use varies depending on the severity of the wasp sting. Antihistamines are used to treat mild urticarial symptoms. Catecholamines are needed in extreme cases (eg, anaphylaxis).
Antihistamines
Class Summary
H1-receptor antagonists block the effects of histamine. Diphenhydramine and hydroxyzine are two of the most widely used H1 blockers for oral and parenteral use in wasp stings.
Diphenhydramine (Benadryl)
For symptomatic relief of symptoms caused by release of histamine in allergic reactions.
Hydroxyzine (Atarax, Vistaril)
Antagonizes H1 receptors in periphery. May suppress histamine activity in subcortical region of CNS.
Glucocorticoids
Class Summary
These agents modulate and decrease the inflammatory response to the sting. Onset of action is delayed for several hours; therefore, glucocorticoids have very little effect in the acute setting. Early administration continues to stabilize the patient.
Methylprednisolone (Solu-Medrol, Medrol)
Steroids ameliorate delayed effects of anaphylactoid reactions and may limit biphasic anaphylaxis. In severe cases of serum sickness, parenteral steroids may be beneficial to reduce inflammatory effects of this immune complex–mediated disease.
Prednisone (Sterapred)
May decrease inflammation by reversing increased capillary permeability and suppressing PMN activity.
Sympathomimetics
Class Summary
Epinephrine and the inhaled beta agonist albuterol reverse the effect of histamine (rather than blocking the effect).
Epinephrine (Adrenalin, EpiPen)
DOC for treating anaphylactoid reactions. Has alpha-agonist effects that include increased peripheral vascular resistance, reversed peripheral vasodilatation, systemic hypotension, and vascular permeability. Beta-agonist effects of epinephrine include bronchodilatation, chronotropic cardiac activity, and positive inotropic effects.
Epinephrine can be administered SC for mild-to-moderate reactions and IV and via ET.
Albuterol (Proventil, Ventolin)
Beta agonist for bronchospasm refractory to epinephrine. Relaxes bronchial smooth muscle by action on beta2 receptors with little effect on cardiac muscle contractility.
Glucagon
DOC for severe anaphylaxis in patients who take beta-blockers (should be used in addition to epinephrine, not as a substitute).
Pancreatic alpha cells of the islets of Langerhans produce glucagon, a polypeptide hormone. Exerts opposite effects of insulin on blood glucose. Glucagon elevates blood glucose levels by inhibiting glycogen synthesis and enhancing formation of glucose from noncarbohydrate sources, such as proteins and fats (gluconeogenesis). Increases hydrolysis of glycogen to glucose (glycogenolysis) in liver in addition to accelerating hepatic glycogenolysis and lipolysis in adipose tissue. Glucagon also increases force of contraction in the heart and has a relaxant effect on GI tract.
Dose used for anaphylaxis is higher than the usual dose of 1 mg (1 U) IV/IM/SC used to treat hypoglycemia.
Antihistamine, H2 Blocker
Class Summary
The combination of H1 and H2 antagonists may be useful in chronic idiopathic urticaria not responding to H1 antagonists alone. It may also be useful for itching and flushing in anaphylaxis, pruritus, urticaria, and contact dermatitis.
Famotidine (Pepcid)
H2 antagonist that, when combined with an H1 type, may be useful in treating allergic reactions that do not respond to H1 antagonists alone.
Pumphrey RS, Roberts IS. Postmortem findings after fatal anaphylactic reactions. J Clin Pathol. Apr 2000;53(4):273-6. [Medline].
Diaz JH. The impact of hurricanes and flooding disasters on hymenopterid-inflicted injuries. Am J Disaster Med. Sep-Oct 2007;2(5):257-69. [Medline].
Barach EM, Nowak RM, Lee TG, et al. Epinephrine for treatment of anaphylactic shock. JAMA. Apr 27 1984;251(16):2118-22. [Medline].
EpiPen EpiPen JR [package insert]. NAPA California: Dey; 2009.
Ruëff F, Przybilla B. Venom immunotherapy. Side effects and efficacy of treatment. Hautarzt. Mar 2008;59(3):200-5. [Medline].
Vachvanichsanong P, Dissaneewate P. Acute renal failure following wasp sting in children. Eur J Pediatr. Aug 2009;168(8):991-4. [Medline].
Rekik S, Andrieu S, Aboukhoudir F, Barnay P, Quaino G, Pansieri M, et al. ST Elevation Myocardial Infarction with No Structural Lesions after a Wasp Sting. J Emerg Med. Mar 26 2009;[Medline].
Jairam A, Kumar RS, Ghosh AK, Hasija PK, Singh JI, Mahapatra D, et al. Delayed Kounis syndrome and acute renal failure after wasp sting. Int J Cardiol. Aug 13 2008;[Medline].
Andrewes CH. The lives of Wasps and Bees. New York, NY: American Elsevier Publishing Co; 1969.
Austen KF. Diseases of immediate sensitivity. In: Fauci AS, ed. Harrison's Principles of Internal Medicine. New York, NY: McGraw Hill; 1998:1860-1869.
Bohlke K, Davis RL, DeStefano F, Marcy SM, Braun MM, Thompson RS. Epidemiology of anaphylaxis among children and adolescents enrolled in a health maintenance organization. J Allergy Clin Immunol. Mar 2004;113(3):536-42. [Medline].
Boxer MB, Greenberger PA, Patterson R. The impact of prednisone in life-threatening idiopathic anaphylaxis: reduction in acute episodes and medical costs. Ann Allergy. Mar 1989;62(3):201-4. [Medline].
Fadal RG. IgE-mediated hypersensitivity reactions. Otolaryngol Head Neck Surg. Sep 1993;109(3 Pt 2):565-78. [Medline].
Golden DK. Immunology Allergy Clinics of North America. 2000;20(3):553-570. [Full Text].
Hauk P, Friedl K, Kaufmehl K, et al. Subsequent insect stings in children with hypersensitivity to Hymenoptera. J Pediatr. Feb 1995;126(2):185-90. [Medline].
Li JT, Yunginger JW. Management of insect sting hypersensitivity. Mayo Clin Proc. Feb 1992;67(2):188-94. [Medline].
Muellman RL, Lindzon RD, Silvers NS. Allergy, hypersensitivity and anaphylaxis. In: Rosen P, ed. Emergency Medicine, Concepts and Clinical Practice. 4th ed. St. Louis, Mo: Mosby Year Book; 1998:2759-2776.
Sampson HA, Munoz-Furlong A, Campbell RL, et al. Second symposium on the definition and management of anaphylaxis: summary report--second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. Ann Emerg Med. Apr 2006;47(4):373-80. [Medline].
Settipane GA, Boyd GK. Anaphylaxis from insect stings. Myths, controversy, and reality. Postgrad Med. Aug 1989;86(2):273-6, 278, 280-1. [Medline].
Thomas M, Crawford I. Best evidence topic report. Glucagon infusion in refractory anaphylactic shock in patients on beta-blockers. Emerg Med J. Apr 2005;22(4):272-3. [Medline].
Print
