To the Editor.—
Horen, in his article, "Insect and Scorpion Sting" (221:894, 1972) neglected to mention the problem of the delayed, localized, allergic reaction to insect stings. This benign, but also very uncomfortable reaction is far more common than the immediate systemic reactions thoroughly discussed by Horen.In the delayed, localized, allergic reaction, swelling and redness appear about 24 hours following the bite and after the localized toxic sting reaction has largely subsided. The swelling may become massive and can interfere with use of the extremity. Red streaks of lymphangitis are common. Itching is usual, although pain is absent or minimal.Clinically, it is important to be aware of localized reactions to insect stings because of the following:
The resemblance of cellulitis may result in the patient being incorrectly treated with antibiotics. The pain and tenderness of cellulitis are usually absent in the localized insect bite allergic reaction.
Patients are often anxious