Patient handout

Insect bites and stings (Hymenoptera, alpha-gal, non-Hymenoptera)

PRODUCTION

1. Your condition

This handout is for insect bites and stings (hymenoptera, alpha-gal, non-hymenoptera). Your care team identified this based on: hymenoptera sting (bee / vespid / fire ant) followed by urticaria / angioedema / wheeze / hypotension (jtf 2016 pmid 28007086).

Other reasons your team may use this plan: large local reaction >10 cm peaking 48-72h post-sting (jtf 2016 pmid 28007086); delayed 3-6h systemic reaction following mammalian meat (alpha-gal syndrome; wilson 2019 pmid 30940532); recurrent large-local mosquito reactions (skeeter syndrome) or papular urticaria from fleas/bed-bugs.

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
ice_and_supportive_care	—	—	—	JTF 2016 (PMID 28007086) — local reactions resolve without pharmacotherapy beyond symptomatic ice/analgesia.

Plan: Sting/bite reaction grade-specific management + venom immunotherapy for systemic reactors

3. When to call your provider

Contact your care team if any of the following happen:

Active anaphylaxis -> ED + allergy.anaphylaxis.v1
Elevated baseline tryptase / mastocytosis suspected -> allergy.mast-cell-activation-syndrome.core.v1 + lifelong VIT
VIT failure (systemic reaction during maintenance) -> reassess venom dose + adjuncts + ddx

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Sting-triggered systemic reaction with airway / CV / two-organ system involvement(life-threatening)
Baseline tryptase elevated or known mastocytosis in patient with prior systemic sting reaction

5. Follow-up

Lifelong: trigger avoidance education (Hymenoptera identification + avoidance + tick-bite prevention), auto-injector carry + technique + expiry monitoring. VIT 3-5 y standard, then reassess sting tolerance + tryptase + risk factors; LIFELONG VIT for high-risk groups. Alpha-gal — periodic re-evaluation of sIgE trend; supervised reintroduction discussion only after years of declining titres.

6. Sources

Guideline: JTF Stinging Insect Hypersensitivity Practice Parameter Update 2016 (Golden DBK et al, Ann Allergy Asthma Immunol 2017-01; PMID 28007086) + EAACI Guidelines on Allergen Immunotherapy: Hymenoptera Venom Allergy (Sturm GJ et al, Allergy 2017-12; PMID 28748641) + Alpha-gal syndrome characterisation (Wilson JM, Commins SP, Platts-Mills TAE et al, J Allergy Clin Immunol Pract 2019-07; PMID 30940532)