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General problems

Patient history with regard to pre-existing conditions and medications:

Known Hymenoptera allergy?

Other pre-existing conditions and medications of relevance.

How severe is the allergic reaction?

Inquire re:

  • When did the sting(s) occur?

Assess:

  • state of consciousness.

Measure:

  • blood pressure/pulse,
  • breathing (respiratory rate)
  • oxygen saturation (pulse oximeter),

Systemic allergic reaction grading system 

Consult Table 7 of

Cardona V, Ansotegui IJ, Ebisawa M, El-Gamal Y, Fernandez Rivas M, Fineman S, Geller M, Gonzalez-Estrada A, Greenberger PA, Sanchez Borges M, Senna G, Sheikh A, Tanno LK, Thong BY, Turner PJ, Worm M. World allergy organization anaphylaxis guidance 2020. World Allergy Organ J. 2020 Oct 30;13(10):100472. PMID: 33204386; PMCID: PMC7607509. 

Are there multiple stings with the risk of a toxic course of envenoming?

Inquire re:

  • When did the stings occur?

Assess:

  • state of consciousness.

Measure:

  • blood pressure/pulse,
  • breathing (respiratory rate).

Count: the number of stings (simultaneously removing any stings remaining in the skin according to first aid methods.

Classification with multiple stings: when toxic symptoms are present, it is likely that >50 stings have occurred.