Primary prevention
Primary avoidance of contact is the most important factor in preventing bites and stings. Common sense goes a long way. It is important to try to avoid exposure at the times the bugs are most active. For example, mosquitoes are most active around dawn and dusk. Most vespid stings occur either while eating and drinking outdoors or while doing yard or garden work; honeybee stings are primarily related to outdoor activity with exposed feet (e.g., barefoot or sandals). These exposures should be avoided, or extra caution used, for people who are susceptible to allergic reactions. Avoidance of perfumes and scented cosmetics seems wise, as some insects are attracted to these odours. There are many commercially available topical sprays and lotions, as well as area-deterrents (e.g., foggers, coils), although these are ineffective for stinging insects. Wearing long sleeves, long pants/trousers, and head nets can prevent most bites; some clothing also comes pre-treated with insect repellents.[30] It is also advisable to look properly before reaching around blind corners or into the back of cabinets to help avoid spider bites and wasp encounters; wearing gloves when it is necessary to reach into places with limited visibility is also helpful. Insect repellents are available in sprays, lotions, and liquids, although these are not often useful at preventing Hymenoptera or arachnid stings and bites.
The US National Institute for Occupational Safety and Health has published information for employers and their workers about the risk of exposure to insects and scorpions, and prevention of stings and bites. CDC: insects and scorpions Opens in new window
Secondary prevention
Patients who suffer severe reactions to insect bites or stings must be educated that they are at high risk of similar (or worse) reactions in the future. Some wounds may require tetanus prophylaxis.
A prescription for two adrenaline (epinephrine) auto-injectors must be given after any episode of anaphylaxis.[2][3][5][28][53] The patient or carer should carry both auto-injectors at all times and be familiar with their use.[24][53]
Immunotherapy with extracted insect venoms
Immunotherapy (desensitisation therapy) with extracted insect venoms may be used to decrease the severity of reactions in patients who are highly sensitive to certain insect stings.[32][33] This can significantly improve quality of life in susceptible patients, but should only be performed by qualified physicians with training in this field as exposure to the venoms carries a small but real risk of serious adverse reactions during treatment.[79][80]
[ 
]
Tetanus prophylaxis
Tetanus-prone wounds (wounds that are deep, dirty, necrotic, or from severe recluse spider envenomation) should receive tetanus prophylaxis if the last immunisation was more than 5 years ago.[61] Wounds not prone to tetanus (e.g., stings, black widow bites) should trigger tetanus prophylaxis if the last immunisation was more than 10 years ago.
Use of this content is subject to our disclaimer