Large local reactions to insect stings.

Large local reactions (LLRs) are IgE-mediated late-phase inflammatory reactions that can cause great morbidity but are associated with a relatively low risk of future anaphylaxis. Patients with LLR may benefit from consultation with an allergist to help clarify the relative risk, to plan the best treatment for future stings, and to determine whether or not to pursue testing or venom immunotherapy (VIT). The chance of anaphylaxis to future stings is <5%, so VIT is not generally recommended to people who have had LLR. Whether to prescribe an epinephrine injector is often determined by the frequency of exposure, the proximity to medical care, and the impact on quality of life. For people who have unavoidable exposure and need treatment almost every year for LLR, VIT can be recommended with confidence that it will significantly and safely reduce the severity of LLR to stings.