Carlson John, Golden David B K
aTulane University, New Orleans, Louisiana bJohns Hopkins University, Baltimore, Maryland, USA.
Curr Opin Allergy Clin Immunol. 2016 Aug;16(4):366-9. doi: 10.1097/ACI.0000000000000289.
Insect stings often induce large local reactions (LLRs) that result in morbidity. These reactions do have an immunologic basis; however, patients presenting with LLRs should be managed differently than those with systemic allergic reactions, as described in this review.
Morbidity results from the inflammation itself along with the iatrogenic consequences of treatment. The prescription of antihistamine medications and the use of antibiotics are generally not indicated for patients with LLRs because of the risks/side-effects of these medications and the low probability of benefit. Some patients are also concerned over the possibility that a future sting will evolve into a life-threatening reaction. Although these reactions do involve IgE, patients are not at sufficient risk to warrant prescription of autoinjectable epinephrine. Venom-specific immunotherapy can be considered when LLRs are frequent and associated with significant impairment.
Clinicians can reduce morbidity from LLRs by reassuring the patients, avoiding medications that result in side-effects when they are not indicated, and referring to an allergist when there are additional concerns, such as frequent impairment.
昆虫叮咬常引发导致发病的大面积局部反应（LLR）。这些反应确实有免疫学基础；然而，正如本综述所述，出现LLR的患者与全身性过敏反应患者的处理方式应有所不同。
发病是由炎症本身以及治疗的医源性后果导致的。由于这些药物的风险/副作用以及获益可能性低，抗组胺药物的处方和抗生素的使用通常不适用于LLR患者。一些患者还担心未来的叮咬会演变成危及生命的反应。尽管这些反应确实涉及IgE，但患者的风险不足以保证开具自动注射肾上腺素的处方。当LLR频繁出现并伴有明显功能障碍时，可考虑进行毒液特异性免疫治疗。
临床医生可以通过安抚患者、避免在无指征时使用会产生副作用的药物以及在存在其他担忧（如频繁功能障碍）时转诊给过敏症专科医生来降低LLR的发病率。
