February 01, 2021 | Black & Kletz Allergy
Bug bites are certainly very common. Almost everyone has been bitten by a bug in their lifetime and almost everyone has had at least a minor local reaction to the bug bite. In some instances, an individual may have a more severe reaction that is not an allergic reaction but it can mimic an allergic reaction. In other cases, however, an individual may actually have a true allergic reaction. In order to differentiate between an allergic reaction and a non-allergic reaction, a consultation with a board certified allergist may be necessary.
There are 4 basic types of reactions that may occur from a bug bite. They are classified as follows:
- Local irritant reaction
- Allergic reaction
- Toxic reaction
- Serum sickness reaction
The first two reactions are by far the most common. Overwhelmingly, a local irritant reaction is the most common of the four reactions. The symptoms of a local irritant reaction may include local redness, pain, itching, and/or swelling. It is generally self-limited and usually resolves on its own without treatment. If treatment is desired, one can use over-the-counter (OTC) antihistamines or OTC topical corticosteroids to treat this type of reaction.
An allergic reaction to a bug bite is not very common, however they do occur. Symptoms can mimic a local irritant reaction but the reaction may be more severe. Additional symptoms may include blistering of the skin, generalized itching of the skin, throat closing sensation, hives (i.e., urticaria), warm feeling, increased heart rate, drop in blood pressure, lightheadedness, dizziness, fainting, wheezing, and/or shortness of breath. It is more common to have true allergic reactions to the venom of stinging insects such as honey bees, yellow jackets, hornets, wasps, and fire ants. The treatment of an allergic reaction to a bug bite is aimed at treating and controlling the symptoms. OTC antihistamines and/or OTC topical corticosteroids are generally adequate enough in to treat this condition. Occasionally, prescription medications such as more potent antihistamines, histamine2-blockers (e.g., Pepcid, Tagamet), leukotriene antagonists (e.g., Singulair), and/or oral corticosteroids may be necessary in order to treat the allergic reaction. Rarely, the use of asthma inhalers (e.g., albuterol) may be necessary in individuals who develop symptoms of asthma which may include shortness of breath, chest tightness, coughing, and/or wheezing. An individual who has had a systemic allergic reaction to a stinging insect (e.g., honey bees, yellow jackets, hornets, wasps, fire ants) should be skin tested by a board certified allergist. If that individual reacts to the venom skin testing, it is strongly recommended that this person go on a course of venom immunotherapy (i.e., allergy shots for stinging insects) as they are very efficacious in preventing anaphylaxis. It is very important that such an individual carry a self-injectable epinephrine device (e.g., EpiPen, Auvi-Q, Adrenaclick) in case they are stung, as insect sting allergies can be fatal. If the epinephrine device is used, it is imperative that the patient go immediately to the closest emergency room. It also should be known that honey bees leave their stingers in their victims and if stung by a honey bee, never pull out the stinger. Instead, one should scrape off the stinger. Pulling out a stinger may cause the pinching of the venom sac, which may in turn cause the venom sac to introduce more venom into the affected person.
A toxic reaction to bug bites or stings occurs when a bug introduces various substances into an individual such as a toxin or venom. Assuming there is not an allergic reaction to the venom, as mentioned above, the venom may act as a poison and cause direct harm to the tissues of the individual. Toxic reactions can occur from one sting or bite from a highly toxic insect or spider, or from multiple stings or bites from insects or spiders not normally considered poisonous. The symptoms of a toxic reaction may include nausea, vomiting, fever, fainting, lightheadedness, pain or redness or swelling at the site of the sting or bite, headache, muscle spasms, seizures, and/or shock. It is even potentially fatal. The treatment of a toxic reaction to bug bites or stings is primarily based on supportive care. Antihistamines and corticosteroids may be used. In addition, standard wound care precautions and treatment should be utilized as it is not uncommon for the site of the bite or sting to become infected. Antibiotics should be used when needed.
The fourth type of reaction that can occur due to a bug bite or sting is serum sickness. Serum sickness can occur as a result of a reaction towards the venom of either insect stings or spider bites. The symptoms generally manifest hours to days after the sting or bite. The classic symptoms may include fever, joint pain, itching, rash or hives, and/or fatigue. Other symptoms may include swollen lymph nodes, enlarged spleen, drop in blood pressure, and/or shock. In addition to venom, medications (e.g., penicillins, cephalosporins, allopurinol), blood products (e.g., transfusions), and antitoxins (e.g., antivenom) have been known to rarely cause serum sickness. The treatment of serum sickness usually entails antihistamines, corticosteroid creams, and/or nonsteroidal anti-inflammatory drugs (e.g., ibuprofen, naproxen). In severe cases, oral corticosteroids are often utilized.
If you or someone you know have experienced an insect sting or bug bite and had more than a minor reaction, the board certified allergists at Black & Kletz Allergy are here to help. We diagnose and treat both adults and children in all facets of allergy, asthma, and immunology. We often see patients for consultations about insect stings and bug bites. Our allergists will perform venom testing on those individuals who meet the requirement for testing. In addition, a specific plan for future stings and/or bites will be discussed with the patient in order to reduce the individual’s fear and confusion regarding reactions to the bite and/or sting. Black & Kletz Allergy has offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. All 3 of our offices have on-site parking. For further convenience, our Washington, DC and McLean, VA offices are Metro accessible. Our McLean office location offers a complementary shuttle that runs between our office and the Spring Hill metro station on the silver line. For an appointment, please call our office or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. Black & Kletz Allergy is dedicated to providing the highest quality allergy care in a relaxed, caring, and professional environment as we have done for over 50 years.
