Can stingray bites cause anaphylaxis?

From the Guidelines

Stingray stings can potentially cause anaphylaxis in some individuals, and immediate medical attention is necessary if symptoms of anaphylaxis occur. Anaphylaxis is a severe, potentially life-threatening allergic reaction that can occur in response to the venom injected during a stingray sting. The venom contains proteins that may trigger an immune response in susceptible people. Symptoms of anaphylaxis from a stingray sting include difficulty breathing, swelling of the face or throat, rapid pulse, dizziness, and a drop in blood pressure, as defined by the presence of sudden respiratory symptoms, reduced blood pressure, or symptoms of end-organ dysfunction, among other criteria 1.

Key Considerations

• The diagnosis of anaphylaxis is based on the presence of sudden onset of symptoms, such as skin or mucosal symptoms, respiratory symptoms, reduced blood pressure, or gastrointestinal symptoms, after exposure to a likely allergen or trigger 1.
• Treatment of anaphylactic reactions caused by stingray stings is the same as the treatment of anaphylaxis from other causes, and typically involves epinephrine (via an EpiPen), antihistamines, and possibly corticosteroids 1.
• The recommended dose of epinephrine is 0.01 mg/kg in children (up to 0.3 mg) and 0.3 to 0.5 mg in adults, depending on the severity of the reaction 1.

Important Notes

• Delayed use of epinephrine can be associated with more serious anaphylaxis or can eventually be ineffective, and patients allergic to insect venom should carry appropriate doses of autoinjectable epinephrine 1.
• Antihistamines and corticosteroids are not a substitute for epinephrine in the treatment of anaphylaxis 1.
• While anaphylactic reactions to stingray stings are relatively rare, anyone with a history of severe allergic reactions should be particularly cautious around stingrays and seek immediate medical care if stung.

From the FDA Drug Label

Emergency treatment of allergic reactions (Type I), including anaphylaxis, which may result from allergic reactions to insect stings, biting insects, foods, drugs, sera, diagnostic testing substances and other allergens, as well as idiopathic anaphylaxis or exercise-induced anaphylaxis. The FDA drug label does not answer the question.

From the Research

Sting Ray Bites and Anaphylaxis

• There is no direct evidence in the provided studies that specifically addresses the risk of anaphylaxis from sting ray bites.
• The studies primarily focus on anaphylaxis caused by insect stings, such as those from wasps, bees, and hornets 2, 3, 4, 5.
• However, one study mentions that anaphylaxis can occur from animal bites and stings, including those from invertebrates and vertebrates, but does not specifically mention sting rays 3.
• Another study discusses the diversity of animals whose bites and stings can cause anaphylaxis, but again, does not mention sting rays explicitly 3.
• A general guide to anaphylaxis notes that it can result from exposure to various offending agents, including insect stings, but does not provide information on sting ray bites 6.

Related Information

• Insect stings are a well-documented cause of anaphylaxis, with a risk of systemic reaction varying between 5% to 10% in large local reactors and 25% to 70% in adults with previous systemic reactions 2, 4.
• Venom immunotherapy is an effective method for preventing sting anaphylaxis, with a success rate of 75% to 98% 2, 4.
• Diagnostic methods, such as venom skin tests and the radioallergosorbent test (RAST), are available for identifying insect sting allergies, but their application to sting ray bites is not discussed in the provided studies 2, 3.