Management of Wasp Sting in Pediatric Patients with Allergies

Immediate Assessment and Treatment

The American Academy of Allergy, Asthma, and Immunology recommends administering intramuscular epinephrine 0.01 mg/kg (maximum 0.3 mg) into the anterolateral thigh immediately for systemic symptoms, as epinephrine is the only first-line treatment for anaphylaxis 1
Epinephrine has no contraindication in life-threatening anaphylaxis, even in patients with cardiovascular disease, with a high strength of evidence 1

For systemic reactions, administer intramuscular epinephrine 0.01 mg/kg (maximum 0.3 mg in children) into the anterolateral thigh immediately, with antihistamines and corticosteroids not being substitutes for epinephrine 1
Repeat dosing of epinephrine may be required for persistent or recurrent symptoms, with a moderate strength of evidence 1

The American Academy of Allergy, Asthma, and Immunology recommends prescribing an epinephrine autoinjector and training caregivers on proper use and indications for emergency self-administration, with a high strength of evidence 3, 1
Refer to an allergist-immunologist for venom-specific IgE testing and consideration of venom immunotherapy (VIT), with a moderate strength of evidence 4, 3, 1, 2

The American Academy of Pediatrics recommends that VIT is generally not necessary in children ≤16 years who have experienced isolated cutaneous systemic reactions, but is recommended for children who experienced respiratory or cardiovascular symptoms, with a moderate strength of evidence 4, 3, 6, 7
VIT reduces the risk of subsequent systemic reactions to less than 5% and is extremely effective, with a high strength of evidence 4, 6

Never delay epinephrine administration in favor of antihistamines or corticosteroids, as epinephrine is the only first-line treatment for anaphylaxis, with a high strength of evidence 1, 2
Be aware that toxic reactions can occur with massive envenomation even without allergy, causing multi-organ dysfunction, with a moderate strength of evidence 1, 2
Patients taking β-blockers or with underlying mastocytosis are at higher risk for severe reactions and may require more aggressive management, with a moderate strength of evidence 3, 1