Most people who get stung by a bee or wasp feel pain, redness, and swelling at the site. That’s normal. But for people with venom allergy, a sting can trigger anaphylaxis, a severe reaction that affects the whole body and can become life-threatening within minutes.
If you’ve had a systemic reaction to an insect sting, or if you carry an epinephrine auto-injector because of one, you should be evaluated by an allergist. Venom immunotherapy is one of the most effective treatments in allergy medicine, with a high long-term success rate when completed properly.
At NY Allergy & Sinus Centers, our physicians test for venom allergy and offer subcutaneous immunotherapy to reduce your risk of a serious reaction from future stings.
Which insects cause venom allergy?
The insects most commonly responsible for allergic reactions in the US belong to the Hymenoptera order. These include:
- Honeybees and bumblebees
- Yellow jackets (the most common cause of systemic reactions)
- Hornets
- Paper wasps
- Fire ants (especially in the southeastern US)
Most stinging insects can sting multiple times. Bees leave their stinger behind; other species do not. Cross-reactivity between some venoms is common, particularly between yellow jackets and hornets, and separate testing is needed to identify which venom or venoms are causing your sensitivity.
What is a systemic reaction?
A local reaction means swelling at the sting site that may be large but stays in the same area. A systemic reaction involves symptoms away from the sting site. These can range from mild (hives, itching, flushing) to severe (throat tightening, difficulty breathing, drop in blood pressure, loss of consciousness).
Systemic reactions require emergency treatment and should always be followed up with an allergist evaluation. People who have had systemic reactions are at significantly higher risk of a severe reaction from a future sting.
Large local reactions, while uncomfortable, do not generally predict anaphylaxis.
Venom allergy testing
We use skin testing and, when appropriate, blood testing (specific IgE) to confirm venom allergy and identify which insect or insects are involved.
Skin prick test
A small amount of diluted venom extract is placed on the forearm and a lancet gently breaks the skin surface. If you’re sensitive, a small raised wheal appears within 15 to 20 minutes.
Intradermal test
A more sensitive option where a small amount of venom extract is injected just under the skin. This is often used when skin prick results are negative despite a clear clinical history.
Specific IgE blood test
A blood draw measures IgE antibodies to individual venoms. This can be useful when skin testing is not possible or when results need confirmation.
Testing is done safely in our office with staff trained to manage reactions. You’ll be observed for a period after testing before leaving.
Venom immunotherapy
Venom immunotherapy (VIT) is subcutaneous allergy shots using purified venom extract. It works by gradually reducing your immune system’s overreaction to venom proteins. Over time, most patients reach a maintenance dose that provides strong protection against anaphylaxis.
Who is a candidate?
Venom immunotherapy is recommended for adults and children over 16 who have had a systemic reaction to a sting and have confirmed venom sensitivity on testing. The decision takes into account the severity of your previous reaction, your lifestyle and sting exposure risk, and your overall health.
Children under 16 who have had systemic reactions limited to skin symptoms (hives, flushing) may not require immunotherapy, but this should be assessed individually.
How does the treatment work?
Treatment starts with a build-up phase. Shots are given once or twice a week at gradually increasing doses until you reach the maintenance dose, typically over 3 to 6 months. After that, maintenance shots are given once a month.
Most patients continue maintenance for 3 to 5 years. After completing a full course, protection often lasts long-term, even after shots stop.
Efficacy
Published data show that venom immunotherapy reduces the risk of anaphylaxis from future stings to around 1 to 3%, compared to 25 to 65% in untreated patients with prior systemic reactions. For people with a history of severe reactions, including cardiovascular or respiratory involvement, immunotherapy is strongly recommended.
What to do while undergoing testing or treatment
Anyone with a known or suspected venom allergy should carry two epinephrine auto-injectors or intranasal epinephrine at all times. Immunotherapy significantly reduces your risk, but it does not eliminate it entirely, and epinephrine remains your first-line response to anaphylaxis.
If you’re stung during treatment, use your epinephrine if you have systemic symptoms, call 911, and contact our office. Do not wait to see if symptoms resolve on their own.
Book a venom allergy evaluation
If you’ve had a serious reaction to a sting, or if you’ve been prescribed an epinephrine auto-injector or or intranasal epinephrine after a sting, call us at (212) 686-6321 or request an appointment online. We see patients at multiple locations across New York City.