What are the indications for referral to secondary care for patients with severe reactions to insect stings?

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

Arrange immediate admission for individuals with symptoms such as shock, angio-oedema, or anaphylaxis, while awaiting emergency transfer to hospital ¹.

Arrange immediate admission for those stung on the mouth, throat, or tongue and at risk of airway obstruction, or around the eyes with risk of compromised vision ¹.

Arrange immediate admission for cellulitis associated with systemic effects or worsening despite treatment ¹.

Arrange immediate admission for fever or persistent lesions following a bite or sting during travel outside the UK, or from unusual insects from tropical/sub-tropical areas ¹.

Patients who have experienced a systemic reaction to an insect sting should be referred to an allergy specialist for further investigation and management ¹.