• Epidemiology: The hymenoptera include bees, wasps, hornets, yellow jackets, and ants. About 100 deaths from hymenoptera stings occur annually in the United States, nearly all due to allergic reactions to venoms. An estimated 0.4–4.0% of the U.S. population exhibits immediate-type hypersensitivity to insect stings.
  • Clinical features:
    • Uncomplicated stings cause pain, a wheal-and-flare reaction, and local edema that subside within hours.
    • Multiple stings (e.g., from wasps, hornets, ants) can lead to vomiting, diarrhea, generalized edema, dyspnea, hypotension, rhabdomyolysis, renal failure, and death.
    • Large (>10-cm) local reactions (e.g., with erythema, edema, warmth, tenderness) progressing over 1–2 days are not uncommon; while they resemble cellulitis, they are in fact hypersensitivity reactions. Such reactions recur on subsequent exposure but are seldom accompanied by anaphylaxis.
    • Serious reactions occur within 10 min (and rarely >5 h) after the sting and include upper airway edema, bronchospasm, hypotension, shock, and death.

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