From the Guidelines
Patients with a wasp allergy should be given an EpiPen if they have experienced or are at risk for severe allergic reactions, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. The standard adult dose is 0.3mg, while children weighing 15-30kg should receive 0.15mg.
Key Considerations
- Patients should carry two auto-injectors at all times, as a second dose may be needed if symptoms persist or recur before emergency medical help arrives.
- The EpiPen should be injected into the outer thigh muscle at the first sign of a severe reaction, which may include difficulty breathing, throat tightness, widespread hives, dizziness, or a drop in blood pressure.
- After using the EpiPen, patients must still seek immediate emergency medical care.
- Epinephrine works by constricting blood vessels to increase blood pressure, relaxing airway muscles to improve breathing, and reducing hives and swelling.
Additional Recommendations
- Patients should also be educated on avoiding wasp stings, recognizing early symptoms of anaphylaxis, and properly storing their EpiPen away from extreme temperatures and light, as suggested by the 2011 practice parameter update on stinging insect hypersensitivity 1.
- It is essential to note that the use of epinephrine is not contraindicated in patients with cardiovascular disease, and repeat dosing may be required for persistent or recurrent symptoms 1.
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. Patients with an allergy to wasps should be given an Epipen if they experience symptoms of anaphylaxis, as it is indicated for the emergency treatment of allergic reactions, including those caused by insect stings.
- Key symptoms that may require Epipen administration include:
- Flushing
- Apprehension
- Syncope
- Tachycardia
- Hypotension
- Convulsions
- Vomiting
- Diarrhea
- Abdominal cramps
- Involuntary voiding
- Airway swelling
- Laryngospasm
- Bronchospasm
- Pruritus
- Urticaria or angioedema
- Swelling of the eyelids, lips, and tongue 2
From the Research
Anaphylaxis Treatment
- Anaphylaxis is a severe, life-threatening allergic reaction that requires immediate treatment 3, 4.
- The primary treatment for anaphylaxis is epinephrine, which should be administered intramuscularly into the lateral thigh 3, 4.
Epinephrine Administration
- Epinephrine is the drug of choice for anaphylaxis and should be administered as soon as possible after the onset of symptoms 4.
- Delayed epinephrine administration is a risk factor for fatal anaphylaxis 5.
- Patients with a history of anaphylaxis, including those with an allergy to wasps, should be prescribed an EpiPen for self-administration in case of an emergency 3, 6.
Insect Sting Allergy
- Insect sting allergy, including allergy to wasps, can cause severe systemic reactions, including anaphylaxis 6.
- Patients with a history of systemic reactions to insect stings should be evaluated for venom immunotherapy (VIT) 6.
- VIT is effective in 80-100% of individuals treated for 3-5 years, but may not be suitable for all patients, including those with systemic mastocytosis or taking certain medications 6.
Treatment Guidelines
- The treatment of anaphylaxis should be guided by the severity of the reaction, with epinephrine being the primary treatment for severe reactions 3, 4.
- Antihistamines and corticosteroids may also be used in the treatment of anaphylaxis, but their use should be guided by clinical judgment and evidence-based guidelines 3, 5.