Acute Wasp Sting Management
Wasp stings with systemic allergic symptoms should be treated as anaphylaxis with immediate intramuscular epinephrine. [1] All patients with significant systemic symptoms should receive emergency evaluation. [1]
Initial Assessment and Risk Stratification
Assessment should focus on airway, breathing, circulation, and skin/mucosal involvement. [1] Anaphylaxis should be suspected with rapid onset of symptoms such as breathing difficulty, hypotension/collapse, or multiple-system involvement after a sting. [1]
Immediate Epinephrine Therapy for Suspected Anaphylaxis
Epinephrine is recommended as first-line therapy for anaphylaxis. [1] Epinephrine should be administered intramuscularly into the anterolateral thigh. [1] Intramuscular epinephrine dosing should be 0.01 mg/kg, up to 0.3 mg in children, and 0.3 to 0.5 mg in adults. [1] Delayed administration of epinephrine is associated with worse outcomes in fatal or near-fatal anaphylaxis. [1]
Airway and Circulation Support During Ongoing Emergency Care
High-flow oxygen and aggressive fluid resuscitation are part of acute anaphylaxis management in emergency settings. [4] Repeat epinephrine dosing should be given if there is no improvement or if symptoms recur, per anaphylaxis emergency treatment guidance. [4]
Local Reaction Care for Isolated Pain, Itching, and Swelling
Stingers should be removed promptly if present to prevent ongoing venom exposure. [8] Local symptoms should be treated with supportive care and antihistamines as needed for itching. [8]
Adjunctive Medications After Epinephrine
Antihistamines can be used for cutaneous symptoms after epinephrine. [8] Bronchospasm should be treated with inhaled beta-agonists in patients with wheeze per emergency anaphylaxis guidance. [4]
Observation and Follow-Up After Acute Episode
Patients treated for anaphylaxis should be observed after emergency treatment to detect recurrence or biphasic reactions. [0] Referral and follow-up after emergency treatment are recommended for suspected anaphylaxis. [0]
Long-Term Prevention for Future Wasp Stings
Patients with a history of systemic allergic reaction to Hymenoptera stings should be evaluated for venom allergy and consideration of venom immunotherapy. [11] Patients with venom allergy at risk for recurrence should carry epinephrine at an appropriate dosage and have access to repeat dosing. [1]
Common Pitfalls to Avoid
Epinephrine should not be delayed while giving only adjunctive therapy. [1] The stinger should not be left in place if present. [8]
Target Outcomes for Treatment
Clinical goals are rapid reversal of life-threatening physiologic compromise and prevention of progression to respiratory failure and shock. [1]