Stinging insect allergy. Avoidance, identification, and treatment.

The incidence of anaphylaxis from insect stings is about 0.4%, most commonly caused by Hymenoptera species. Diagnosis is aided if the patient can reliably identify the insect, and more specific diagnosis depends on venom skin testing for individual sensitivity. Radioallergosorbent testing is also used but fails to identify about 15% to 20% of sensitivities. Avoidance of high-risk situations is the best approach for patients with known sensitivity. Treatment includes relief of local symptomatic reactions, pharmacologic arrest of anaphylaxis, and venom immunotherapy.