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Wasp Stings Medication

  • Author: Carl A Mealie, MD, FACEP, FAAEM; Chief Editor: Joe Alcock, MD, MS  more...
 
Updated: Sep 22, 2015
 

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).

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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)

 

Diphenhydramine is used for symptomatic relief of symptoms caused by release of histamine in allergic reactions.

Hydroxyzine (Atarax, Vistaril)

 

Hydroxyzine antagonizes H1 receptors in the periphery and may suppress histamine activity in the subcortical region of the CNS.

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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 the delayed effects of anaphylactoid reactions and may limit biphasic anaphylaxis. In severe cases of serum sickness, parenteral steroids may be beneficial to reduce the inflammatory effects of this immune complex–mediated disease.

Prednisone (Sterapred)

 

Prednisone may decrease inflammation by reversing increased capillary permeability and suppressing PMN activity.

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Sympathomimetics

Class Summary

Epinephrine and the inhaled beta agonist albuterol reverse the effect of histamine (rather than blocking the effect).

Epinephrine (Adrenalin, EpiPen)

 

Epinephrine is the drug of choice for treating anaphylactoid reactions. It 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 subcutaneously for mild-to-moderate reactions and intravenously and via an endotracheal tube.

Albuterol (Proventil, Ventolin)

 

Albuterol is a beta-agonist for bronchospasm refractory to epinephrine. It relaxes bronchial smooth muscle by action on beta2 receptors, with little effect on cardiac muscle contractility.

Glucagon

 

Glucagon is the drug of choice 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. It 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). It increases the hydrolysis of glycogen to glucose (glycogenolysis) in the liver in addition to accelerating hepatic glycogenolysis and lipolysis in adipose tissue. Glucagon also increases the force of contractions in the heart and has a relaxant effect on the GI tract.

The dose used for anaphylaxis is higher than the usual dose of 1 mg (1 U) IV/IM/SC used to treat hypoglycemia.

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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)

 

Famotidine is an H2 antagonist that, when combined with an H1 type, may be useful in treating allergic reactions that do not respond to H1 antagonists alone.

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Contributor Information and Disclosures
Author

Carl A Mealie, MD, FACEP, FAAEM Assistant Professor, Department of Emergency Medicine, Hofstra North Shore-LIJ School of Medicine; Chief of Operations, Department of Emergency Medicine, Long Island Jewish Medical Center

Carl A Mealie, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physicians, American Medical Association, New York Academy of Medicine, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Max Vernon Wisgerhof, II, MD Fellowship Program Director, Department of Endocrinology and Metabolism, Henry Ford Hospital

Max Vernon Wisgerhof, II, MD is a member of the following medical societies: American Thyroid Association, Endocrine Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Joe Alcock, MD, MS Associate Professor, Department of Emergency Medicine, University of New Mexico Health Sciences Center

Joe Alcock, MD, MS is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Lisa Kirkland, MD, FACP, FCCM, MSHA Assistant Professor, Department of Internal Medicine, Division of Hospital Medicine, Mayo Clinic; Vice Chair, Department of Critical Care, ANW Intensivists, Abbott Northwestern Hospital

Lisa Kirkland, MD, FACP, FCCM, MSHA is a member of the following medical societies: American College of Physicians, Society of Hospital Medicine, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Acknowledgements

Alan S Multz, MD Associate Professor of Clinical Medicine, Albert Einstein College of Medicine; Program Director, Internal Medicine Residency, Associate Chairman, Department of Medicine, Long Island Jewish Medical Center

Alan S Multz, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Chest Physicians, American College of Physicians, American Thoracic Society, and Society of Critical Care Medicine

Disclosure: Astellas Pharmaceutical Honoraria Consulting; Merck Pharmaceutical Honoraria Speaking and teaching; The Medicines Company Honoraria Consulting; Schering Plough Honoraria Speaking and teaching; Wyeth Pharmaceuticals Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching

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