Management of stinging insect hypersensitivity: a 5-year retrospective medical record review.
Objective: To review frontline providers' documented care and recommendations for imported fire ant [Solenopsis invicta] and flying insect hypersensitivity reactions. Methods: A retrospective medical record review of emergency department and primary care clinic visits due to insect stings in 2 military medical facilities in the USA (one in San Antonio, Texas and the other in Charleston, South Carolina) was performed between 1 November 1999 and 30 November 2004. Using the International Classification of Diseases, Ninth Revision codes, the medical records were selected for review to identify patients with potential insect hypersensitivity. Results: 769 medical records from patients who experienced an insect sting were reviewed. Of 120 patients with a systemic reaction, 66 (55.0%) received a prescription for injectable epinephrine, and 14 (11.7%) were given information regarding avoidance of the offending insect. 47 patients with systemic reactions (39.2%) were referred to an allergist. Of 28 patients who kept their appointments and underwent skin testing, 3 had negative results and 25 (89%) had positive results and were advised to start immunotherapy. Conclusion: The adherence to the stinging insect hypersensitivity practice parameter recommendations is poor. Many patients who have experienced a systemic reaction after an insect sting and have sought medical care are not afforded an opportunity for potentially lifesaving therapy.