What are the recommended first-line treatments for localised allergic reactions to insect bites in adults?

Recommended first-line treatments for localized allergic reactions to insect bites in adults include:

• Use of oral antihistamines such as chlorphenamine to help reduce itching, although this use is generally off-label and evidence is limited.
• Application of topical corticosteroids, for example hydrocortisone 1%, to reduce inflammation and itching; this is licensed for insect bite reactions despite limited trial evidence.
• Oral analgesics like paracetamol or ibuprofen may be recommended to ease pain, but evidence supporting their effectiveness is lacking.

For large local reactions, oral antihistamines and/or corticosteroids are often used, but corticosteroids should not be prescribed if there is a possibility of infection, and if used, the lowest effective dose for the shortest duration is advised.

Topical antipruritics, topical antihistamines, and topical anaesthetics sold over-the-counter have uncertain value and may cause irritant skin reactions, so are not routinely recommended.

Referral to secondary care with an allergy specialist should be considered if symptoms are severe or persistent.

Summary: First-line management focuses on oral antihistamines and topical corticosteroids to reduce itching and inflammation, with oral analgesics for pain relief as needed, while avoiding corticosteroids if infection is suspected.

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