What criteria should I use to decide whether to refer a patient with a severe reaction to an insect sting to secondary care?

Refer a patient with a severe insect sting reaction to secondary care if they have had a suspected systemic hypersensitivity or toxic reaction to an insect sting or bite ¹.

Arrange immediate admission to Accident and Emergency for anyone who is suspected of having a systemic hypersensitivity or toxic reaction, or has had a previous systemic allergic reaction to the same type of sting ¹.

Refer if the patient has been stung on the mouth, throat, or tongue and is at risk of airway obstruction, or around the eyes with risk of compromised vision ¹.

Refer if cellulitis is associated with systemic effects or worsening despite treatment in primary care ¹.

Arrange referral for people stung by an unusual insect or from tropical/sub-tropical areas, or if they have systemic effects such as fever or persistent lesions, especially if the sting occurred abroad ¹.

In cases of suspected anaphylaxis, after emergency treatment, refer to a specialist allergy service for further investigation and management ³.