Insect bites and insect venom allergy

In the German-speaking region, about two to three percent of the population are allergic to insect bites. They suffer from an insect venom allergy, often also referred to as an insect sting allergy. However, it is the insect venom that causes the dangerous immune reaction and can lead to anaphylactic shock in the worst case. Some sufferers hardly dare to go outside in spring and summer, but luckily most insects are not out to sting us. With the right behavior, bee and wasp stings can be well avoided. It is different with mosquitoes or ticks, whose stings and bites are not painful but stealthy. Both insect bites and allergies can be treated with medication. In the case of an insect venom allergy, there is always the possibility of hyposensitization.

This article deals with insect bites, stinging insects, and insect venom allergy. You can click on each section to access it directly.

What are insect bites and how can you recognize them?

Insect bites refer to all skin injuries caused by the stinger or mouthparts of insects. Insect bites are also often referred to as "stings" in this sense. Insects sting to defend themselves or to feed and it is not always immediately apparent which animal stung you. Since some insects - for example, mosquitoes or biting flies - sting painlessly or even inject pain-relieving substances, symptoms often appear only minutes after the sting. The stings of bees, wasps, or hornets, on the other hand, cause immediate severe pain.

Typical symptoms of insect bites include swelling and redness around the sting site. Sometimes a small red dot is visible where the insect stung. Small welts can also occur, and noticeable itching often develops within minutes. Some insect bites can cause a slight numbness at the sting site, while others are accompanied by noticeable pain.

If you have an allergy to the respective insect venom, much stronger, even life-threatening symptoms can occur. For example, if muscle cramps or severe headaches occur, if you feel chills or develop a fever, you should seek medical help in any case. Dizziness, weakness, or drowsiness are other warning signs. It becomes particularly critical if shortness of breath occurs, which often announces itself with a feeling of tightness in the chest. Call an ambulance immediately in case of shortness of breath or consciousness disturbances!

Which insects sting in this country and why do they do it?

In Germany, there are many insects and other arthropods that can sting or bite. Fortunately, there are no insects with life-threatening venom in our latitudes. However, for example, a wasp sting in the area of the mucous membranes of the mouth can cause life-threatening swelling even without an insect venom allergy. Otherwise, only allergy sufferers usually have to reckon with dangerous consequences of an insect sting.

The stingers of wasps or hornets serve both self-defense and prey hunting. They usually become aggressive only when people get too close to their nests. Mosquitoes use their stingers to prepare for feeding. Parasitic crawlers such as ticks, lice, or bedbugs feed on the blood of their hosts - they do not specifically target humans but are often "collected" during nature walks, forestry work, or cuddling with pets. Below you will find an overview of the typical stinging insects in Germany.

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  Bees are peaceful insects that sting only in the absolute last resort. This is because the bee's stinger hooks into the target, causing the bee to tear the stinger along with the venom gland from its body and perish. It gives its life to defend the beehive while the stinger continues to pump venom into its enemy. Therefore, humans are usually only stung by bees if they accidentally step on the animals or swat at them. If a bee sting occurs, the stinger should be removed immediately. The sting is associated with a sharp pain, and a crater-like wound often forms in the center of the swollen, red sting site.
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  Wasps sting more frequently than bees because they often come close to humans in search of food. They can also use their stinger repeatedly. However, not all wasps are equally aggressive. The brightly yellow-black common wasps are attracted to human food - they love barbecue meat and sweets. Therefore, they often come very close to the mouth, where they can still smell the consumed food, increasing the risk of stings in the mouth area. The darker and smaller Saxon wasps, on the other hand, feed on other insects and are still quite relaxed even near their nests. Wasps also only sting when they feel threatened. Their sting causes severe pain and leaves a red swelling whose center is sunken like a crater.
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  Hornets are unjustly feared because although they are very large and look threatening, they rarely sting. Danger usually only occurs when you stumble directly over a hornet's nest. However, their sting is extremely painful - more painful than a wasp sting. The sting site can itch severely, and symptoms such as palpitations, dizziness, and nausea are also known, although this may also be related to the pain. Otherwise, the hornet sting differs little from the wasp sting. Even their venom is similar to wasp venom and can trigger a reaction in wasp allergy sufferers.
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  Bumblebees are very peaceful and almost never sting. They have a stinger, which they can use in case of danger - they do not "bite," as is often claimed. The large, fluffy insects, however, have a calm temperament and even warn intruders by raising their abdomen. Most bumblebee stings occur when someone steps on a bumblebee barefoot. Then the sting is very painful and resembles the consequences of a bee sting, with the bumblebee retaining its stinger. Bee allergy sufferers often also react to bumblebee venom.
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  Mosquitoes are the true pests because the small, inconspicuous insects are almost impossible to escape. Who hasn't spent sleepless summer nights with the high-pitched buzzing of mosquitoes in their ears, only to find small, itchy welts on various parts of the body in the morning. Female mosquitoes drink blood to nourish their brood and prefer to sting where the skin is nice and thin. They inject their saliva into the wound to inhibit blood clotting for a while using proteins contained in it and to suck up the blood like through a straw. These proteins cause the typical welts and the unpleasant itching. In rare cases, the mosquito enzymes can trigger a mosquito bite allergy, which can be accompanied by extensive hives and swelling of the mucous membranes.
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  Black flies are mosquitoes that look like small flies and cut into the skin with their sharp mouthparts. The escaping blood is sucked up with a short proboscis. Black flies also inject a pain-relieving substance, so itchy swelling occurs only after a while. The itching is stronger than with a mosquito bite. The sting site is often severely reddened, and some blood may even escape.
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  Horseflies are often found on pastures and near lakes. The animals are also called "horseflies" because they feed on the blood of grazing animals. Horseflies have very sharp mouthparts that cut a hole in the skin like small knives. The escaping blood is then immediately slurped up. Horsefly bites are extremely painful and, even without an allergy, cause severe swelling and intense itching in humans. Often, even bruises form around the sting site. If you have a horsefly venom allergy, extreme swelling and shortness of breath can occur.
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  Fleas are annoying little crawlers that mainly infest mammals and sometimes birds but can also jump onto humans. Flea bites appear as small, intensely itchy red punctures, often in a line. The fleas themselves are hard to find because they only hop onto the host to feed and then hide again in cushions and carpets. Getting rid of them often requires drastic measures. So-called "flea bombs" can fumigate the parasites in infested apartments. There is a flea allergy - this mainly affects dogs and cats. The animals suffer from severe inflammation and crusting of the scratched skin areas.
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  Bed bugs are parasites that originally lived mainly in the fur of bats. Over time, they have also moved on to livestock such as poultry and from there to humans. The creatures are now mainly found near human dwellings. Bed bugs feel comfortable in old mattresses and come out at night to drink small amounts of blood from various parts of the host. In the morning, the bug bites appear as numerous red spots and welts.
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  Head lice are parasites that nest in human hair and feed on blood from the capillaries of the scalp. They also use their saliva to prevent the blood from clotting for a while. The enzymes in the lice's saliva trigger immune reactions such as swelling and itching. If the bites are scratched, inflammation can occur. If lice bites do not heal over a long period, so-called excoriations can develop on the sensitive scalp, providing entry points for dangerous germs. Special lice combs and various hair preparations help to get rid of the pests and their eggs.
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  Ticks are not insects but belong to the mites, which in turn belong to the arachnids. Their bite is one of the most feared "insect bites." Although ticks are not considered allergens, the tiny animals can carry dangerous germs. In addition to tick-borne encephalitis (TBE), some ticks also transmit the insidious pathogen of Lyme disease. An allergy associated with tick bites is the "meat allergy," which has recently become more common in the USA. The so-called alpha-gal syndrome can cause some types of meat and other foods to trigger immune reactions. In Europe, only a few cases are known so far.
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  Grass mites: sit on tall grasses and wait for a host to come by and brush them off. The tiny mites feed on the blood of their hosts and also bite humans when they are "collected" while walking through tall grass. Grass mite bites leave red welts that sometimes still itch after days.
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  Spider bites are extremely rare and largely harmless with the native spider species. The yellow sac spider is considered the only species with potent venom that can cause severe swelling, dizziness, nausea, and fever. However, their bite is also dangerous only to particularly sensitive individuals or insect venom allergy sufferers.

Insect bites - react quickly and treat correctly

How to react to an insect bite depends on which insect has stung and where the sting is located. The stings of bees, wasps, and hornets are immediately noticeable by severe pain. If a stinger is still in the wound, it should be removed immediately - dislodged bee stingers continue to pump venom into their target for several seconds. Immediate cooling - for example, with gel packs from the refrigerator - helps against the pain and counteracts the swelling. In the case of stings in the throat and mouth area or even in the mouth, extreme caution is required - do not hesitate to call emergency services if shortness of breath, dizziness, or severe nausea occur.

Insect venom allergy sufferers can be prescribed special emergency kits to carry with them on trips to the countryside. This is at least sensible for known severe allergies, as these kits contain antihistamines and an adrenaline syringe that can prevent circulatory collapse in an emergency. Seek medical advice if you believe you have an insect sting allergy. More on this below.

Neutralizing or breaking down the insect venom

The stings of mosquitoes and other bloodsuckers often do not hurt and are only noticed hours later when they swell and itch. The itching caused by the venom is common to practically all insect stings - and it is always important not to give in to it. Insect stings usually heal quickly. However, if scratched, countless germs can enter the wound and cause infections. The treatment of acute insect stings aims to neutralize the venom as quickly as possible.

Cool packs, cold compresses, or cooling gels suppress the itching, but mosquito bites or grass mite bites can also itch for days. In this case, it is better to neutralize the venom itself. Here, heat actually achieves the better effect, as the enzymes in the insect venom break down when exposed to high temperatures. As a home remedy, for example, a tealight can be heated and the hot wax poured onto a mosquito bite. It is not recommended to use a spoon heated over an open flame, as you can quickly burn yourself. In any case, it is most efficient to use a modern insect bite healer.

Insect bite healers are electronic devices that usually resemble a pen in shape and size. At their tip, these pens have a small contact surface that can precisely cover a mosquito bite and be heated to about 50 degrees Celsius for a few seconds at the push of a button. Using the insect bite healer is associated with a short pain. For stubborn stings, it may be necessary to apply the device more than once. Sting healers are particularly suitable for mosquito bites. According to the manufacturers, some models are also supposed to help against wasp or bee stings.

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Ticks can be removed with the help of special tick tweezers, tick cards, or fine tweezers. It is important to grasp the tick as close to the skin as possible, just behind its head. Do not squeeze the animal, as this motivates the tick to regurgitate its stomach contents into the wound in its death throes. Since the pathogens of Lyme disease are in the digestive tract, they will also enter the wound - if present. Otherwise, it takes several hours for the pathogens to enter the body. The sooner a tick is removed, the better. The tick must be pulled out as straight as possible with slow traction. Avoid twisting movements, as this can cause the tick's head to break off and remain stuck.

Inflamed insect stings or tick bites, as well as remnants of stingers and mouthparts or tick heads, should always be treated by a doctor. In the case of tick bites, it is also important to watch for a large-scale redness spreading around the bite site. Often - but not always - this indicates Lyme disease. If detected early, the disease can now be treated well.

Insect venom allergy - dangers and treatment options

Insect venom allergies are quite rare - but those who suffer from it must sometimes reckon with life-threatening consequences even from a single wasp sting. The allergy to wasp stings is the most common and affects about two-thirds of allergy sufferers. Bees and hornets follow closely, while allergies to the venom of mosquitoes or biting flies are extremely rare. Since insect sting allergies belong to the Type I allergies (immediate type), the first symptoms appear immediately after the sting. The allergic reaction to the insect venom can range from a slight intensification of the usual symptoms of an insect sting to a life-threatening anaphylactic shock.

The allergic shock is announced by various symptoms, the severity of which can increase rapidly. The course and extent of the symptoms can vary from case to case. Nevertheless, a classification into four anaphylaxis grades can be made, describing the course of an anaphylactic shock.

• Grade 1: An anaphylactic shock begins after the insect sting with severe itching and a noticeable swelling of the sting site. Rash can occur around the sting and other parts of the body. Often, the first grade is accompanied by an undefined feeling of anxiety. If you know you suffer from an insect venom allergy, you should already call emergency services and use your emergency kit.
• Grade 2: Symptoms then occur that differ significantly from the usual consequences of an insect sting. Swelling appears away from the sting site, accompanied by nausea and abdominal cramps, up to vomiting and/or diarrhea. In addition to hoarseness and early signs of shortness of breath, there is often an increased heart rate with a simultaneous drop in blood pressure. Severe dizziness can occur. By now, it should be clear that emergency help is needed - call 112.
• Grade 3: In addition to noticeably wheezing breathing, increased shortness of breath occurs in the third grade, often accompanied by swelling of the larynx and increasing problems with swallowing and speaking. Cold sweat, pale skin, and bluish discolorations of the lips or fingernails indicate acute circulatory problems. The affected individuals are very weak and drowsy.
• Grade 4: This leads to life-threatening circulatory collapse, resulting in unconsciousness and cessation of breathing and heartbeat. Affected individuals are no longer able to help themselves.

An emergency kit contains medications that can slow down or stop an anaphylactic shock. These include, among other things, medications for asthma, as asthma sufferers with insect venom allergies are particularly at risk. Using the emergency kit cannot replace medical care. So if you are in a situation where you need to use your anaphylaxis emergency kit, be sure to also place a medical emergency call. An emergency kit must be prescribed - anyway, you should always have a suspected insect sting allergy clarified by specialists. Once detected, the allergy may even be curable.

Hyposensitization for insect venom allergy

Hyposensitization against insect venoms is now a well-tested procedure with high success rates. Especially in the area of common wasp and bee allergies, most patients show no or hardly any reactions to the insect venom after completing the multi-year therapy. Patients are administered a tiny amount of the allergen to allow the immune system to gradually get used to the stimulus. The procedure must be repeated regularly over several years, with the dose of the allergen slowly increasing. Typically, the hyposensitization of insect allergies takes place in two stages.

In the initial phase, patients receive subcutaneous injections with diluted insect venom. This treatment can take place as an inpatient "rush immunotherapy" under medical supervision or as an outpatient buildup with weekly injections at an allergy practice. In principle, insect stings should be avoided during the buildup phase. Thus, outpatient treatment usually begins in November when no wasps or bees are around.

This is followed by a maintenance phase of three to five years. During this time, the hyposensitization is continued with monthly administrations of the allergen. If the course is ideal, no allergic symptoms are seen. In most cases, the allergy can be reduced to a harmless level. If you have a job - for example, as a gardener or beekeeper - that involves dealing with wasps, bees, and hornets, it is advisable to continue the maintenance phase permanently. Be sure to seek medical advice!

How to avoid insect bites?

Many types of insect bites can indeed be almost completely avoided - even if you are outdoors in nature. However, more effort may be required with some pests like mosquitoes or ticks.

Pollen collectors like bees and bumblebees or insect hunters like hornets and wasps are not out to sting humans. We are irrelevant to them - however, humans can become a target if they deliberately or accidentally disturb or attack the animals. So it is advisable not to walk barefoot across blooming meadows. If you step on a bee, it stings in a death struggle. These insects usually only become aggressive if their nest is threatened or they feel personally attacked.

Avoid swatting at the animals or making hectic movements. If you accidentally come across a wasp nest, move away slowly and calmly. Do not try to destroy wasp or hornet nests! First, these species are protected and important for the environment, and second, such an undertaking would be very dangerous. Call the fire department or local beekeepers - they should be able to help you. Beekeepers, for example, can also collect and secure swarms of bees looking for a new home.

Headgear and long clothing that covers the body completely protect against insect bites. Insect venom allergy sufferers should wear long pants, closed shoes, and gloves when gardening to be better protected against "sting accidents." Some insects are attracted to brightly patterned or dark clothing. So wear lighter clothes. Also, avoid wide sleeves and pant legs where insects could get lost. Open skin areas can be treated with a special insect repellent spray. These sprays emit odors that are unpleasant to insects and often keep mosquitoes, horseflies, or ticks away for hours.

Ticks sit on tall grasses and shrubs and are brushed onto the skin or clothing when you, for example, walk through a blooming meadow. They sometimes wander around for hours or days until they find a good spot for bloodsucking. A tick spray spoils their fun and motivates them to leave the host. In any case, smells play an important role - mosquitoes are attracted by our sweat odor, while other insects mistake perfume for the scent of fascinating flowers.

Especially wasps often become a nuisance in bakery shops or at barbecues because, depending on the species, they are attracted by the smell of sweets, grilled meat, or fresh fruit. There is a fairly effective trick here: Offer them a tempting alternative. For example, cut up some grapes and place them in a bowl at the other end of the garden. Or carefully move the piece of cake most wasps are sitting on a few meters away. Since the insects follow the scent trail of their "colleagues," many wasps usually gather where other wasps are already at work.

Insect bites in other world regions

Please note that the focus of this blog article is on local insect species. In many tropical and subtropical travel destinations, insects and other crawlers with much more potent venom and the ability to transmit more dangerous diseases are native. Allergic reactions can also occur differently if caused by an exotic insect. Always inform yourself about necessary vaccinations and potential health risks before traveling to remote regions of the world.