1. A sharp, smarting sensation, as of a wound or astringent.
2. A puncture wound made by a venomous barb or spine, e.g., of a marine animal or an insect.
Pain at the puncture site is almost universally reported. The patient may also develop local swelling, which at times is massive, and localized itch. Generalized hives, dizziness, a tight feeling in the chest, difficulty breathing, swelling of the lips and tongue, stridor, respiratory failure, hypotension, syncope, or cardiac arrest may also occur. Anaphylactic reactions such as these require prompt effective treatment.
If the stinger is still present in the skin, it should be carefully removed. Ice should be applied locally to limit inflammation at the site of the sting and systemic distribution of venom. Diphenhydramine (or other antihistamine) should be given by mouth or parenterally; moreover, if signs and symptoms of anaphylaxis exist, epinephrine should be administered. Corticosteroids are given to reduce the risk of delayed allergic responses. Patients who have had large local reactions or systemic reactions to stings should be referred for desensitization (immunotherapy). In this treatment, gradually increasing dilutions of venom are injected subcutaneously over weeks or months until immunological tolerance develops.
Those with a history of anaphylactic reactions to venom should avoid exposure to the vectors, e.g., ants, bees, snakes, wasps, as much as possible. Protective clothing, e.g., specialized gloves or shoes, may prevent some stings. Cosmetics, perfumes, hair sprays, and bright or white clothing should be avoided to prevent attracting insects. Because foods and odors attract insects, care should be taken when cooking and eating outdoors.
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