Hymenoptera Stings 

  • Author: Carrie de Moor, MD; Chief Editor: Scott H Plantz, MD, FAAEM   more...
 
Updated: Apr 26, 2010
 

Background

Hymenoptera stings account for more deaths in the United States than any other envenomation. The order Hymenoptera includes Apis species, ie, bees (European, African), vespids (wasps, yellow jackets, hornets), and ants. Although most deaths result from immunologic mechanisms, some are from direct toxicity. Severe anaphylactoid reactions occur occasionally when toxins directly stimulate mast cells. While the vast majority of stings cause only minor problems, stings cause a significant number of deaths.

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

Target organs are the skin, vascular system, and respiratory system. Pathology is similar to other immunoglobulin E (IgE)–mediated allergic reactions. Anaphylaxis may occur and is typically a result of sudden systemic release of mast cells and basophil mediators.[1]Urticaria, vasodilation, bronchospasm, laryngospasm, and angioedema are prominent symptoms of the reaction. Respiratory arrest may result in refractory cases.

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Epidemiology

Frequency

United States

Ants sting 9.3 million people each year. Other Hymenoptera species account for more than 1 million stings annually. Anaphylaxis secondary to Hymenoptera envenomation affects roughly 3% of the general population.[2] Systemic reactions leading to life-threatening manifestations occurs in approximately 0.4-0.8% of children and 3% of adult patients.[3]

Mortality/Morbidity

  • Large local reactions occur in 17-56% of those stung. In one study, 1-2% experienced a generalized reaction, and 5% sought medical care.
  • Individuals with large local reactions have a 5-10% risk of subsequent development of a severe systemic reaction if re-stung.[3]
  • An updated review of animal-related deaths in 2005 determined that Hymenoptera stings accounted for 533 deaths in the United States from 1991-2001. This number represented 70.2% of all venomous animal-related fatalities in the United States during this period.[4]
  • In 1989, 32 deaths were reported from fire ant stings in Texas, Florida, Louisiana, and Georgia.[5]
  • Wasps and bees cause 30-120 deaths yearly in the United States.

Race

No race predilection exists.

Sex

Hymenoptera stings of all types are more common in males than in females, probably because of more frequent exposure.

Age

Although most deaths from toxic reactions occur at extremes of age, frequency of bites is not age dependent. Peak incidence of death from anaphylaxis is in people aged 35-45 years.

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Contributor Information and Disclosures
Author

Carrie de Moor, MD  Adjunct Faculty, John Peter Smith Hospital, Emergency Medicine; Attending Physician, 24 Hour Emergency Room, Centennial Medical Center, Del Sol Emergency Department

Carrie de Moor, MD is a member of the following medical societies: American Medical Association and Texas Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Hemant H Vankawala, MD  Attending Physician, 24 Hour Emergency Room, Houston and Dallas; Attending Physician, Baylor University Medical Center; Medical Director, Big Bend National Park; Medical Director, Terlingua Fire and EMS; Medical Director, MedCare Ambulance Company

Hemant H Vankawala, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Emergency Medicine Residents Association, Society for Academic Emergency Medicine, and Texas Medical Association

Disclosure: Nothing to disclose.

Randy Park, MD  Chair, Associate Professor, Department of Emergency Medicine, Denton Regional Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Dan Danzl, MD  Chair, Department of Emergency Medicine, Professor, University of Louisville Hospital

Dan Danzl, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Kentucky Medical Association, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD  Regional Director of Pharmacy, Sacred Heart & St. Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

James Steven Walker, DO, MS  Clinical Professor of Surgery, Department of Surgery, University of Oklahoma Health Sciences Center

James Steven Walker, DO, MS is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, and American Osteopathic Association

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Scott H Plantz, MD, FAAEM  Associate Clinical Professor of Emergency Medicine, Rosalind Franklin University of Medicine and Science, Chicago Medical School; Medical Director, WeCare Med, Inc

Scott H Plantz, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

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Two fire ant stings that are 24 hours old (Randy Park, MD)
A paper wasp (Randy Park, MD)
A paper wasp (Randy Park, MD)
A paper wasp (Randy Park, MD)
 
 
 
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