Therapy goals
- Symptom control
- Prophylaxis of anaphylactic shock
Therapy recommendations
See below therapy recommendations on:
- Acute local reaction to wasp/bee sting: local therapy with glucocorticoids or antihistamines.
- Anaphylaxis to wasp/bee sting:
- Prednisolone equivalent (glucocorticoids), 100-500 mg.
- Epinephrine (sympathomimetics) [first-line agent.]
- Volume replacement: initial 500-2,000 ml (adults), 20 ml/kg (children) [agent of choice].
- Long-term therapy for bee/wasp sting allergy:
- In case of previous increased local reaction (emergency kit): glucocorticoids; antihistamines.
- In case of earlier systemic immediate type reaction (emergency set): glucocorticoids, 100 mg prednisolone equivalent p.o.; antihistamines, up to 4 times the daily dose p.o.; epinephrine (auto-injector i.m.)
- In case of previous unusual sting reaction (emergency kit); it should be carried, if necessary, the drug according to the previous symptomatology.
- Emergency medication in children: Prednisolone, 100 mg supp, 2-5 mg/kg p.o. (< 15 kg); dimetindene (antihistamine); epinephrine: 1:10,000, 0.1 ml/kg (< 7.5 kg), auto-injector 0.15 mg (7.5-30 kg), auto-injector 0.3 mg (> 30 mg) [first-line agent for anaphylactic shock].
- In patients with marked bronchial obstruction (narrowing of the airways) in previous anaphylaxis or bronchial asthma: rapid-acting β2-sympathomimetic (act dilating on the bronchial system) for inhalation.
- Specific immunotherapy (SIT) – see under “Further therapy” (due torisk factors – see also under insect bites/consequential diseases/prognostic factors)Note: Some patients react with severe systemic reactions in the up-dosing phase of SIT. When dosing such patients, it may help to pretreat with omalizumab (monoclonal antibody to immunoglobulin E).
