University of South Florida

USF Health expert authors NEJM clinical article on stinging-insect allergies

Tampa, FL (April 10, 2014) — Patients with severe allergies to stings from bees, wasps, hornets, fire ants and other insects should seriously consider immunotherapy, the recommended standard treatment that can prevent life-threatening reactions, concludes an article co-authored by internationally-recognized allergists/immunologists from the University of South Florida (USF) and the University of North Carolina (UNC) at Chapel Hill. 

The clinical practice article, featured in today’s New England Journal of Medicine, also recommends learning to carry and self-administer an auto-injectable syringe containing epinephrine, which counteracts the allergic reaction to insect venom, at the earliest signs of an acute response.

Bee on a flower

The paper was written by lead author Thomas B. Casale, MD, professor of medicine in the Division of Allergy and Immunology, USF Health Morsani College of Medicine, and A. Wesley Burks, MD, chairman of the Department of Pediatrics, UNC School of Medicine.

It describes the case of 24-year-old woman who reported being stung on her upper lip while drinking from a can of soda at a picnic, and within 5 minutes experiencing a cascade of reactions including swollen lips, light-headedness, difficulty swallowing, flushing and hives. She was rushed to a local emergency department, where she was treated, observed and discharged with injectable epinephrine.  The article provides a review of strategies for managing allergies to stinging insects.

“Stinging insects are the number one cause of venomous deaths in the United States,” Dr. Casale said. With snakes the venom itself kills, but with stinging insects you can die from anaphylaxis, the severe systemic allergic reaction to the venom.”

When most people are stung by an insect, the reaction is typically localized – some redness, itching and swelling at the site of the sting.  Cold compresses, cortisone cream and/or oral antihistamines can help ease these bothersome symptoms.

However, up to about 4 percent of the population is allergic to the venom of a stinging insect. For these adults and children, the more rapid the onset of symptoms of anaphylaxis, the more severe the reaction tends to be.

“So, if you are stung by an insect and develop any acute symptoms, especially getting lightheaded, short of breath or breaking out in hives, immediately seek emergency treatment,” Dr. Casale said.  “The sooner you treat acute symptoms, the less likely you are to have a catastrophic event like death.”


Lead author Dr. Thomas Casale is a professor in the USF Health Morsani College of Medicine Division of Allergy and Immunology.

Adults or children who have had a severe allergic reaction to an insect sting should be referred to an allergist/immunologist for diagnostic testing and consideration of immunotherapy, the authors say.  Immunotherapy involves a series of injections that expose the patient in a medically-controlled environment to tiny amounts of venom.   The therapy is intended to stimulate the immune system to build up tolerance over time to the venom, helping to prevent severe allergic reactions to a future insect sting. Immunotherapy is a process that takes several years, although for those at higher risk, maintenance doses may need to continue indefinitely.

Immunotherapy for insect stings “reduces the risk of having another severe systemic allergic reaction from more than 60 percent to about 5 percent,” Dr. Casale said.

With spring pollination in bloom and summertime heat approaching, it’s prime time for stinging insects to encroach on outdoor activities.  The allergy experts provide some prevention strategies for those with venom allergies, including:

–         Avoid gardens and keep outdoor areas free of exposed garbage that draws insects.

–         Wear closed-toe shoes and avoid going barefoot when outdoors.   Yellow jackets may build nests in the ground and fire ant mounds are popping up underfoot.

–         Don’t wear brightly colored clothing, perfumes, lotions or scented soaps that make you a more attractive target.

–         Cover food and drink at picnics.  The case scenario of the woman being stung while drinking from a soda can is not uncommon. “Yellow jackets, especially, will fly inside the can and sting when a person drinks,” Dr. Casale said. “It’s better to drink from a cup, where you can see what you’re drinking.”

–         Make sure you or a child’s caregiver is educated about how and when to use an epinephrine auto-injector, and bring it with you whenever there is a chance of a sting. Don’t leave the auto-injector on car dashboards or other hot places, because heat and sunlight breaks down the epinephrine.

                                                                                                  -USF Health-
USF Health’s mission is to envision and implement the future of health. It is the partnership of the USF Health Morsani College of Medicine, the College of Nursing, the College of Public Health, the College of Pharmacy, the School of Biomedical Sciences and the School of Physical Therapy and Rehabilitation Sciences; and the USF Physician’s Group. The University of South Florida is a Top 50 research university in total research expenditures among both public and private institutions nationwide, according to the National Science Foundation. For more information, visit



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