How do I manage systemic reactions to an insect bite or sting?
• If a severe systemic reaction occurs, such as wheezing or other signs of respiratory distress, or hypotension: • Treat urgently as for anaphylaxis and admit to hospital. • If there are symptoms of systemic toxicity that suggest impending anaphylaxis (e.g. abdominal pain, vomiting, rhinitis and conjunctivitis, or a sense of impending doom): • Treat as for anaphylaxis and admit to hospital. • If generalized urticaria occurs, but the person is otherwise well: • Give an oral antihistamine and an oral corticosteroid. • Offer a non-sedating antihistamine to control daytime symptoms. • Consider giving an additional sedating antihistamine at night if the itch is interfering with sleep. • In adults, give prednisolone 40 mg once a day, and in children give 1–2 mg/kg body weight once a day. • Continue prednisolone for 3–5 days, depending on the severity of the reaction. • Advise the person to seek urgent medical help if the rash worsens, swelling develops which involves the mouth or throat, or
