Insect stings are a serious health threat for some children who have allergies to insect venom. Venom released in the stings of bees, yellow jackets, hornets, wasps and fire ants can trigger a rare, potentially life-threatening allergic reaction called anaphylactic shock in some children. More often, children may suffer a milder reaction such as nausea or hives.
Insect stings can cause a reaction in any person with allergies to insect venom. Children are more likely to suffer serious reactions to insect stings than adults. This is because venom can more easily affect their lower body mass and smaller airways. However, the majority of fatalities occur in adults, according to several studies.
Parents can help their children avoid insect stings by taking certain precautions and teaching their children about insect habitats and the potential dangers of insect venom. Many children with a history of allergic reactions to insect venom have found allergy shots (immunotherapy) to be a great help in preventing symptoms. Children, parents and other caregivers at school or camp should carry an allergy kit and know how to use it.
About insect stings and children
Insect-sting or insect-bite venom can be among the most dangerous allergens for children. Most children who are stung by bees, yellow jackets, hornets, wasps and fire ants have little to fear. The normal reaction to insect stings is for the child to experience pain, redness, swelling and itching at the site of the sting.
However, those with allergies to the venom are likely to experience more pronounced effects. A mild allergic reaction may result in nausea, hives, swelling and other discomforts. At the other extreme, a rare reaction called anaphylactic shock can impair breathing and heart functions, leading to death in some victims.
Studies show that children are more likely than adults to suffer symptoms of an allergic reaction after being stung. However, adults are more likely to have serious or life-threatening symptoms such as anaphylactic shock. Despite the potential danger from insect sting allergies, serious allergic reactions are rare. There are only between 40 and 150 deaths each year from allergic reactions to insect stings in the United States, according to the American College of Allergy, Asthma and Immunology (ACAAI).
A child cannot suffer an allergic reaction the first time they are stung by an insect. However, it may be difficult to determine the first time a child is stung, and even more difficult to determine which type of insect was responsible for a sting. Merely because a child has been stung previously without reacting does not mean they will not have an allergic reaction to the next sting. Instead, the initial encounter may lead to sensitization, in which the immune system overreacts to the insect venom and creates immunoglobulin E (IgE) antibodies to fight it. These antibodies trigger an allergic reaction the next time the body encounters the insect venom.
The next time a person is stung, these antibodies cause mast cells to release chemicals such as histamine, which can cause inflammation within the body. Highly allergic individuals may experience anaphylaxis, in which fluid leaks from the bloodstream into the tissues, causing swelling and lowering blood pressure. Bronchial tissues may also swell, causing breathing difficulties. This anaphylactic reaction can quickly progress to life-threatening anaphylactic shock.
Those who experience an anaphylactic episode have a 60 percent chance of having a repeat reaction the next time they are stung, according to the ACAAI, and reactions can be the same or worse. Children with insect allergies may be advised to get allergy shots to desensitize them to insect stings and bites. They may also be prescribed an allergy kit that contains an epinephrine injection in case of emergencies.
Insect bites rarely cause anaphylactic shock. However, some children suffer large local reactions to the bites of certain insects. As children grow older, these reactions tend to reduce in intensity. For many years, it has been thought that the majority of children outgrew allergies to insect venom. But a study at Johns Hopkins University in Maryland has cast doubt upon this theory. Allergy shots are the best prevention of further allergic reaction to insect venom in children.
Potential causes of insect stings
Almost all allergies to insect venom are delivered via a stinger. Spiders, which are not actually insects, are the exception. Spiders deliver their venom by biting. Stinging insects are most active in the summer and early fall, and are most dangerous near their nests. The most likely culprits in an insect sting are members of the Hymenoptera family, which includes:
- Honeybees. These insects have round bodies that appear “fuzzy.” They are dark brown with yellow markings.
- Yellow jackets. These insects are black with yellow markings.
- Paper wasps. These insects have slender, elongated bodies that are black, brown or red with yellow markings.
- Hornets. These insects have black or brown bodies with white, orange or yellow markings.
- Fire ants. These insects have bodies that are reddish-brown to black in color. They are found only in the Southeastern region of the United States.
Signs and symptoms of insect stings
Symptoms of an allergic reaction to an insect sting may appear right away, or may be delayed as much as four hours to a week later. Symptoms may be minor, or may manifest as a potentially life-threatening reaction known as anaphylactic shock. Children are more likely than adults to suffer reactions to insect stings, as the venom can more powerfully affect their lower body mass and smaller airways.
Parents should seek immediate medical help if their children are stung and experience any of the following symptoms:
- Sudden breathing difficulties (e.g., shortness of breath, wheezing)
- Weakness, collapse or unconsciousness
- Severe swelling of the eyes, lips or genitals (angioedema)
- Stomach cramps
- Low-grade fever
Young children suffering a severe allergic reaction may not be able to express the symptoms they are experiencing to a parent or other caregiver. Hoarseness, difficulty talking, coughing, choking and drooling may suggest that the child is experiencing anaphylaxis.
Parents should also seek immediate medical help for a child stung in the mouth, on the face or on the neck. A child who has had severe reactions to an insect sting in the past should receive emergency medical attention as well.
Diagnosis and treatment of insect stings
If a child has been stung by a honeybee or bumblebee an adult should remove the stinger by gentling scraping across the site with a blunt object like a credit card. The stinger should not be pulled out because this can release more venom from the attached venom sac. Wasps and other stinging insects do not leave their stingers behind.
Children and their parents are likely to be unaware of the child’s allergy until after an insect sting has triggered an allergic reaction. Children who may have experienced such a reaction should be taken to a physician, who can treat them as appropriate for the symptoms with antihistamines, corticosteroids or epinephrine.
Patients with insect allergies should be referred to an allergist who can diagnose the specific insect allergy. Once an allergy is diagnosed, many prescription, over-the-counter and home-based remedies are available to help relieve symptoms of an allergic reaction to an insect sting.
In addition, a physician may suggest that a child participate in allergy shot treatments, also known as immunotherapy. The goal of immunotherapy is to build up a patient’s tolerance to an allergen. For example, children at risk from insect stings receive very low-dose injections of the insect venom over a period of weeks until they build up a tolerance to it. Once the tolerance has been established, the likelihood of suffering a severe allergic reaction to a sting is reduced.
A child who has insect sting allergies should carry an allergy kit that contains injectable epinephrine with them at all times, and be taught how to use it. This rescue medication should also be available at home, school, camp, or other places where the child could be exposed to insects and all the child’s caregivers should know how to administer the drug.
One dose of epinephrine is not always enough to reverse the symptoms of anaphylaxis. Anaphylaxis can also recur several hours later. Therefore, children who receive an injection of epinephrine should still receive medical attention. It is also advisable that children have more than one dose of epinephrine available.
When epinephrine is not available, medical attention should be immediately sought, either through calling an ambulance or driving the patient to a hospital.
Children with insect sting allergies may also benefit from wearing a medic-alert bracelet.
Prevention methods for insect stings
Parents can help their children avoid insect stings by educating them about the potential dangers associated with insect venom. In addition, parents and children should observe the following rules:
- A child that is stung by an insect should immediately alert an adult.
- Children should avoid wearing bright-colored or flowered-print clothing during seasons when insects are present.
- Insist that children wear long-sleeve shirts and long pants when playing outdoors during insect season.
- Children should avoid wearing loose-fitting clothing when spending time outside. Insects can become trapped between loose clothing and the skin.
- Avoid the use of scented soap, perfumes, shampoos or other material that may make a child smell like a flower.
- Children should not walk or play outside barefoot. Sandals and other open-toe shoes should also be avoided.
- Children should be aware of the kinds of places that insects may live and frequent. Bees and wasps are found in flowers, shrubs, picnic areas, garbage cans and on beaches.
- Children should know not to disturb sites that might host hives, such as large trees, stumps, logs and large rocks.
- Tell children to stay away from locations that contain hives and nests. When a hive or nest is discovered, it should be removed by professionals.
- Teach children not to flail or slap at insects and to refrain from other behavior that might trigger aggression in the insect. Children should be taught to stay calm and walk away slowly when they encounter a potentially stinging insect.
- Teach children not to drink from cans or straws unless they can see inside them. Yellow jackets often hide in these places.
- Teach children that if they are stung, they should immediately leave the area where the sting took place. Insects such as honey bees emit an alarm pheromone when they sting, which alerts other bees to the need to attack.
Parents can also reduce their child’s risk of being stung by an insect by keeping food covered when eating outdoors, storing garbage outside in containers with tight-fitting lids and keeping car windows up when driving.
While insect repellents such as DEET have virtually no effect on stinging insects, they can be very effective in repelling biting insects such as mosquitoes, ticks, fleas, chiggers and biting flies.
The American Academy of Pediatrics recommends that children use products with DEET concentrations of 10 percent or less. DEET should not be used on children younger than 2. If using a repellent other than DEET, make sure it is safe for children. The following precautions should be observed when using repellent on children:
- Apply repellent in a well-ventilated area.
- Do not apply repellent on cuts or open wounds.
- Do not apply near the nose, mouth or eyes.
- Keep repellent off a child’s hands, as children often wipe their noses or mouths with their hands.
- Wash children’s skin with soap and water after they come back inside.
- Keep children out of the sun for extended periods, as DEET can make sunscreens less effective.
- DEET is not water soluble and will last up to eight hours.
Questions for your doctor
Preparing questions in advance can help parents to have more meaningful discussions with their child’s physicians. Parents may wish to ask their child’s doctor the following questions about insect stings and children:
- What symptoms may indicate that my child is allergic to an insect?
- What tests will you use to diagnose my child?
- Is an insect sting allergy dangerous to my child?
- Is my child likely to be allergic to other insects as well?
- What are some ways my child can avoid being stung?
- What should I do if my child is stung by an insect?
- Under what circumstances should I seek medical attention for my child after an insect sting?
- Are there any medications available that can treat an insect sting allergy?
- Is my child a candidate for allergy shots?
- Is it possible my child will outgrow this allergy?