What is the most serious initial reaction to insect exposures?

Updated: Jun 21, 2018
  • Author: Boyd (Bo) D Burns, DO, FACEP, FAAEM; Chief Editor: Joe Alcock, MD, MS  more...
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Although illness related to insect exposure in a particular locale may be easily recognizable, the emergency physician must also be aware of more exotic insect-related diseases as humans travel to more remote areas of the country and the world. Additionally, exotic insects are often kept as pets (sometimes illegally) or can be encountered in shipments of foreign origin (eg, mantises, stick insects).

Anaphylactic shock

Anaphylactic shock is the most notable immediate risk associated with insect exposures. Hypersensitivity to otherwise harmless insect saliva, venom, body parts, excretions, or secretions can cause systemic responses in some individuals. Diagnosing the early phases of a systemic allergic reaction preceding anaphylactic shock is of paramount importance in treating any patient in whom insect exposure is suspected. Severe anaphylaxis can be fatal in as little as 10 minutes.

The reoccurrence rate is 40-60% for insect stings. Hence, the patient should be instructed on how to avoid future exposure to the causative agent, if possible. A prescription and clear instructions on the use of an epinephrine autoinjector should be provided to patients when the risk of another reaction is judged to be substantial. [8]

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