Anaphylaxis from insect stings results in a significant number of fatalities each year. At least 40 deaths occur in the United States yearly from reactions to insect stings, and it is likely that additional deaths are unrecognized and therefore not reported. Data indicating the prevalence of fatalities from insect stings can never adequately reflect the individual tragedy associated with the sudden and unexpected loss of a friend or relative. Although most insect stings produce only local discomfort, potentially life-threatening reactions occur in both children and adults.

Stinging insect hypersensitivity is a complex and challenging condition. With recognition of the importance of venom extracts in the diagnosis and treatment of patients who had experienced reactions to insect stings, a scientifically-based standardized approach to management seemed a reasonable assumption 20 years ago. It has since become clear that there are still important questions that need to be answered, such as the criteria to be used in determining the duration of venom immunotherapy. It is therefore essential that the practicing physician understand basic approaches to the management of stinging insect hypersensitivity so that evaluation and treatment can be appropriately individualized for each patient.

A workgroup of the Joint Task Force on Practice Parameters was responsible for the initial preparation of the “Parameter on the diagnosis and management of stinging insect hypersensitivity.” That workgroup, chaired by John E. Moffitt, MD, and consisting of internationally recognized experts in the field of stinging insect allergy, provided the Task Force with the first draft of this parameter, consisting of a text with references, as well as summary statements reflecting the key points to be considered in each section. Jay M. Portnoy, MD, as a member of the Task Force, then accepted responsibility for the initial editing of this document. The Task Force added an algorithm and annotations to support the steps recommended in the algorithm. After evaluation by the entire Task Force, the complete document was then reviewed by selected individuals within the American Academy of Allergy, Asthma and Immunology (AAAAI) and the American College of Allergy, Asthma and Immunology (ACAAI).

As is the case with previous parameters produced by the Joint Task Force on Practice Parameters, this document is based on a careful review of the literature and reflects the experience of experts in the area of stinging insect hypersensitivity. When the medical literature did not provide a definitive recommendation on a given issue or there was significant difference of opinion among experts, options were given for the management of patients based on the current state of practice. The result is a concise, focused, evidence-based, consensus practice parameter that will serve as a map for the management of stinging insect hypersensitivity.

The Joint Task Force on Practice Parameters would like to thank those who have so willingly given of their time and expertise in the development of this important parameter. This includes the members of the Workgroup on Stinging Insect Hypersensitivity, as well as reviewers from the AAAAI and the ACAAI. The Task Force would like to acknowledge in particular the support and contributions made by John E. Moffitt, MD, and David B. K. Golden, MD. In addition, the Task Force is indebted to the leadership of both the AAAAI and the ACAAI for their recognition of the importance of developing practice parameters and their support in this endeavor.