In this article we review allergic reactions to stinging insects (hymenoptera) and biting insects (mosquitoes). We describe the first proven case of sensitization and anaphylaxis to hymenoptera in an Icelander. Yellow jackets, honeybees, paper wasps and hornets cause most sting reactions. The vespidae species were first seen in Iceland in 1973. Since that time, these insects have inhabited the island in ever increasing numbers. Symptoms range from local reactions to systemic anaphylaxis and even death. Accurate diagnosis is important as treatment with venom immunotherapy can prevent repeated reactions by at least 95%. Local reactions in children and adults and even widespread urticaria in children should not be treated with immunotherapy. Practical measures to avoid these insects and the characteristics of each species are discussed. Physicians and other health care workers must recognize the symptoms of insect sting allergy and know when to refer to an allergist for skin testing and possible immunotherapy.
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