Hymenoptera Stings

Updated: Aug 30, 2017
  • Author: Randy Park, MD; Chief Editor: Joe Alcock, MD, MS  more...
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Overview

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 (see the images below). Most deaths result from immediate hypersensitivity reactions and anaphylaxis. Severe anaphylactoid reactions occur occasionally when toxins directly stimulate mast cells. In addition to immunologic mechanisms, some injury occurs from direct toxicity. While the vast majority of stings cause only minor problems, stings cause a significant number of deaths.

Western paper wasp (Mischocyttarus flavitarsis) bu Western paper wasp (Mischocyttarus flavitarsis) building a nest. By Sanjay Acharya (self-made at Sunnyvale, California, USA). Courtesy of Wikimedia Commons.
Yellow jacket. By Richard Bartz, Munich aka Makro Yellow jacket. By Richard Bartz, Munich aka Makro Freak (Own work). Courtesy of Wikimedia Commons.
Fire ants. US Department of Agriculture. Courtesy Fire ants. US Department of Agriculture. Courtesy of Wikimedia Commons.

See Arthropod Envenomation: From Benign Bites to Serious Stings, a Critical Images slideshow, for help identifying and treating various envenomations. See also All About Allergies: Be Ready for Spring, to help identify a variety of allergens and symptoms.

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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 is a common and life-threatening consequence of Hymenoptera stings 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]

According the US Bureau of Labor Statistics, from 2003 to 2010, bees accounted for 52 fatal occupational injuries, wasps/yellow jackets 14, and ants 4 [4] . Additionally, fatal occupational injuries involving insects, by year, are as follows [4] :

  • 2003: 6 deaths
  • 2004: 10 deaths
  • 2005: 15 deaths
  • 2006: 10 deaths
  • 2007: 11 deaths
  • 2008: 10 deaths
  • 2009: 9 deaths
  • 2010: 12 deaths

International

A 2009 study from Costa Rica reported on Hymenoptera sting fatalities over a 22-year period (1985-2006). The annual number of deaths varied from 0-6 (2.4 deaths/year average), with a total of 52 deaths over the study period. Most deaths were in older (>50 years) and younger (<10 years) males. [5]

From 1979 through 1978, 7 fatalities from wasp stings were reported in Australia, all from rural areas; 5 of the 7 had a history of wasp or bee venom allergy. [6]

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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Prognosis

Most stings resolve with no residual complaints. Large local reactions do not predispose patients to generalized reactions in the future. Less severe generalized reactions precede most fatal reactions.

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. [7]

In 1989, 32 deaths were reported from fire ant stings in Texas, Florida, Louisiana, and Georgia. [8]  

Wasps and bees cause 30-120 deaths yearly in the United States.

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Patient Education

Educate all patients on how to avoid stings.

For patient education resources, see the Bee and Wasp Stings Center, Environmental Exposures and Injuries Center, Allergy Center, and Allergic Reaction and Anaphylactic Shock Center, as well as Bee and Wasp Stings and Severe Allergic Reaction (Anaphylactic Shock).

For related information, see Medscape's Allergy Resource Center.

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