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Wasp Stings Workup

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

Laboratory Studies

Laboratory data are usually not helpful in patients with mild symptoms. Patients who present with anaphylaxis resulting from a wasp sting may benefit from studies such as arterial blood gas, CBC count, electrolytes, BUN and creatinine, glucose, and liver function studies in order to provide their baseline values as part of the admission profile.

Patients may have mild leukocytosis related to demargination from catecholamine release.

Arterial blood gas values reflect the pathophysiology of the illness progression. The initial pH level should be normal or may be slightly elevated to reflect a respiratory alkalosis due to anxiety-produced hyperventilation with the corresponding decrease in the partial pressure of carbon dioxide (PCO2). As the patient becomes more hypotensive, the pH level may begin to fall. Conversely, this fall may also be due to increased respiratory distress with bronchospasm. This can be due to several factors. A respiratory acidosis can be caused by carbon dioxide retention from the respiratory bronchospasm and the development of pulmonary edema. At this point, the partial pressure of oxygen (PO2) level begins to fall. The decreased pH level can also be due to the development of a metabolic acidosis as the patient becomes more hypotensive and tissue perfusion decreases.


Imaging Studies

Lateral neck radiography to evaluate for soft tissue swelling may be helpful in patients who experience throat tightness after a wasp sting, although direct fiberoptic visualization of the airway (eg, with a Machida scope) is optimal.

Perform chest radiography in patients who present with dyspnea or chest tightness or who have an anaphylactic episode after a wasp sting. Chest radiography should be obtained by using a portable machine in the emergency department (ED) with equipment for aggressively managing the airway close to the bedside.


Other Tests

Perform an ECG on patients who experience palpitations, chest tightness, dyspnea, or lightheadedness after a wasp sting.

A baseline peak flow measurement helps to assess the progression of distress in patients who present with wheezing, dyspnea, or prolongation of the expiratory phase of respiration after a wasp sting.



Flexible fiberoptic visualization of the larynx and vocal chords may be useful to exclude laryngeal edema or spasm. This should be performed by a clinician experienced in emergency airway management; use caution to avoid precipitating laryngospasm.

Contributor Information and Disclosures

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.


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.


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

  1. Starr CK. A simple pain scale for field comparison of Hymenoptera stings. J Entomol Sci. 1985 April. 20:225-31.

  2. Pumphrey RS, Roberts IS. Postmortem findings after fatal anaphylactic reactions. J Clin Pathol. 2000 Apr. 53(4):273-6. [Medline].

  3. Nittner-Marszalska M, Cichocka-Jarosz E. Insect sting allergy in adults: key messages for clinicians. Pol Arch Med Wewn. 2015 Sep 3. pii: AOP_15_083:[Medline].

  4. Forrester JA, Holstege CP, Forrester JD. Fatalities from venomous and nonvenomous animals in the United States (1999-2007). Wilderness Environ Med. 2012 Jun. 23(2):146-52. [Medline].

  5. Guenova E, Volz T, Eichner M, Hoetzenecker W, et al. Basal serum tryptase as risk assessment for severe Hymenoptera sting reactions in elderly. Allergy. 2010 Jul. 65(7):919-23. [Medline].

  6. Diaz JH. The impact of hurricanes and flooding disasters on hymenopterid-inflicted injuries. Am J Disaster Med. 2007 Sep-Oct. 2(5):257-69. [Medline].

  7. Sun Z, Yang X, Ye H, Zhou G, Jiang H. Delayed encephalopathy with movement disorder and catatonia: A rare combination after wasp stings. Clin Neurol Neurosurg. 2012 Dec 21. [Medline].

  8. Ito K, Imafuku S, Nakayama J. Rhabdomyolysis due to Multiple Wasp Stings. Case Rep Dermatol Med. 2012. 2012:486724. [Medline]. [Full Text].

  9. Nandi M, Sarkar S. Acute kidney injury following multiple wasp stings. Pediatr Nephrol. 2012 Dec. 27(12):2315-7. [Medline].

  10. Barach EM, Nowak RM, Lee TG, et al. Epinephrine for treatment of anaphylactic shock. JAMA. 1984 Apr 27. 251(16):2118-22. [Medline].

  11. Brown SA, Seifert SA, Rayburn WF. Management of envenomations during pregnancy. Clin Toxicol (Phila). 2013 Jan. 51(1):3-15. [Medline].

  12. EpiPen EpiPen JR [package insert]. NAPA California: Dey. 2009.

  13. Ruëff F, Przybilla B. Venom immunotherapy. Side effects and efficacy of treatment. Hautarzt. Mar 2008. 59(3):200-5. [Medline].

  14. Ludman SW, Boyle RJ. Stinging insect allergy: current perspectives on venom immunotherapy. J Asthma Allergy. 2015. 8:75-86. [Medline].

  15. Vachvanichsanong P, Dissaneewate P. Acute renal failure following wasp sting in children. Eur J Pediatr. 2009 Aug. 168(8):991-4. [Medline].

  16. 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. 2009 Mar 26. [Medline].

  17. 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. 2008 Aug 13. [Medline].

  18. Andrewes CH. The lives of Wasps and Bees. New York, NY: American Elsevier Publishing Co; 1969.

  19. Austen KF. Diseases of immediate sensitivity. Fauci AS, ed. Harrison's Principles of Internal Medicine. New York, NY: McGraw Hill; 1998. 1860-1869.

  20. 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. 2004 Mar. 113(3):536-42. [Medline].

  21. Boxer MB, Greenberger PA, Patterson R. The impact of prednisone in life-threatening idiopathic anaphylaxis: reduction in acute episodes and medical costs. Ann Allergy. 1989 Mar. 62(3):201-4. [Medline].

  22. Fadal RG. IgE-mediated hypersensitivity reactions. Otolaryngol Head Neck Surg. 1993 Sep. 109(3 Pt 2):565-78. [Medline].

  23. Golden DK. Immunology Allergy Clinics of North America. 2000. 20(3):553-570. [Full Text].

  24. Hauk P, Friedl K, Kaufmehl K, et al. Subsequent insect stings in children with hypersensitivity to Hymenoptera. J Pediatr. 1995 Feb. 126(2):185-90. [Medline].

  25. Li JT, Yunginger JW. Management of insect sting hypersensitivity. Mayo Clin Proc. 1992 Feb. 67(2):188-94. [Medline].

  26. Muellman RL, Lindzon RD, Silvers NS. Allergy, hypersensitivity and anaphylaxis. Rosen P, ed. Emergency Medicine, Concepts and Clinical Practice. 4th ed. St. Louis, Mo: Mosby Year Book; 1998. 2759-2776.

  27. 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. 2006 Apr. 47(4):373-80. [Medline].

  28. Settipane GA, Boyd GK. Anaphylaxis from insect stings. Myths, controversy, and reality. Postgrad Med. 1989 Aug. 86(2):273-6, 278, 280-1. [Medline].

  29. Thomas M, Crawford I. Best evidence topic report. Glucagon infusion in refractory anaphylactic shock in patients on beta-blockers. Emerg Med J. 2005 Apr. 22(4):272-3. [Medline].

A paper wasp (Randy Park, MD)
A paper wasp (Randy Park, MD)
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