Dr. Dave Stukus Profile picture
Jun 21, 2019 10 tweets 5 min read Read on X
The #FirstDayofSummer means increasing outdoor activities and tis the season for stings.

Many people are misdiagnosed as having venom allergy...and others with true allergy do not receive proper treatment.

I'll address some misconceptions in this thread ⬇️ #FridayThoughts
Venom is naturally irritating - a NORMAL response after being stung is redness, swelling, pain, itching.

Treatment is supportive with ice, pain meds, antihistamines.
This is not infection (no need for antibiotics). This does not increase risk for future allergy.
Large local reactions are common: Exaggerated swelling at the same body part that was stung. I get these with stings - makes my hand swell twice normal size.

Also not an allergy. Treatment is supportive with ice, pain meds, antihistamines.
Generalized hives after being stung is worrisome in adults > 16 yrs old but not in children.
Adults with this story should be evaluated with allergy testing & consider immunotherapy.
Kids not at increased risk for future anaphylaxis.
ANYONE who has had anaphylaxis after being stung should be evaluated by an allergist with venom allergy testing and consideration for immunotherapy.

Prior anaphylaxis from venom = high risk for future anaphylaxis. Immunotherapy can dramatically decrease that risk to < 10%.
Venom allergy testing has a lot of false positive results, which can lead to unnecessary use of allergy shots. Skin test preferable to blood testing.

Venom allergy is NOT inherited - no need to test siblings/children.
Also no reason to test "just to make sure".
It is well known that suspected identification of the stinging insect is often incorrect.

Venom allergy testing must include honey bees, wasps, hornets and yellow jackets.
Honey bees are the only stinging insect that typically leaves stinger in place - it is barbed and attached to the abdominal cavity. Bees often die after stinging, partly why they are docile and don't sting unless provoked.

Don't squeeze the stinger! There's still venom in sac
Avoidance measures should be a part of any allergy management plan, but not always easy with venom. Some easy steps to take to avoid future stings.

I, for one, never drink out of a can left outdoors - I don't want to swallow a curious yellow jacket!
As always, this thread should never replace medical advice from your personal doctor or clinician. Hopefully this info clarified some common misconceptions.

I hope everyone has a fun filled summer without any stings!

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More from @AllergyKidsDoc

Feb 6, 2022
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You should be asking why or how this would ever come up during a visit for food allergies.

This one may surprise you. A little thread ⬇️
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This was a brand new patient to me. I started as I always do:
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Then I heard about prior suspected food allergy reactions & avoidance of certain foods.

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May 17, 2020
As businesses & restaurants reopen, it’s important to remember that #COVID19 is still here, waiting for opportunities to infect as many people as possible.

We can take some basic measures to limit spread, but it requires an understanding of why that’s still important. Thread⬇️
We still don’t know how many people have been or are currently infected with #COVID19.

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This article offers a good discussion: usatoday.com/pages/interact…
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Last week, the FDA announced a ‘boxed warning’ & new discussion points with patients regarding side effects.

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It is NOT an antihistamine.

It has NEVER been a 1st line treatment for asthma/allergies.
Montelukast can help some people as an add on treatment when their allergic rhinitis or asthma is not well controlled with other medications.

It is commonly misused by itself to treat allergic rhinitis, which is not effective. New FDA warning encourages not using as such.
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Oct 8, 2019
For my #TuesdayThoughts thread, I'd like to discuss farts.

My farts, to be specific.

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The 1st link informed me that I may have a food intolerance, so I looked that up ⬇️
I quickly found some handy dandy quizzes designed to see if I may have a food intolerance.

Question 1 - excessive flatulence. Check.
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Sep 28, 2019
10% of people reading this believe they are allergic to penicillin, but >95% of you are not actually allergic.

Inappropriate labeling of penicillin allergy is rampant and leads to unnecessary avoidance, use of less effective alternatives, & antibiotic resistance. Thread⬇️
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#nationalpenicillinallergyday
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Sep 14, 2019
Lots of information surrounding yesterday's FDA meeting to approve the 1st treatment for peanut allergy.

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I'll address some important points to consider in this #SaturdayMorning thread ⬇️

abcn.ws/2UV2PUZ
Results of Aimmune's Phase 3 trial were published in 2018: nejm.org/doi/full/10.10…

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AR101 peanut immunotherapy has a goal daily dose of 300 mg.

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