Written by Dr Afonso Caires, Consultant Allergist, Dublin Allergy Centres, Beacon Hospital and Bon Secours Hospital
Source: Irish Pharmacy News, June 2026, page 28.
Preparing for the Irish Summer Season
In recent years, consultations for insect bites, stings, and outdoor allergic reactions have increased. With more people holidaying locally and spending time farming, hiking, gardening, and participating in outdoor activities, pharmacists are increasingly becoming the first point of contact for advice and early management.
Most insect bites and stings in Ireland are mild, but recognising potentially serious systemic reactions remains essential.
Common Presentations in Ireland
In the Irish climate, most bites and stings arise from a relatively predictable group of insects and arthropods, particularly during spring and summer months.
Midges and Mosquitoes
These commonly present with small erythematous pruritic papules, particularly after evening outdoor exposure near water or wooded areas. Reactions are generally mild but can become more pronounced in atopic individuals and children.
Horseflies (Clegs)
Horsefly bites are painful because they cut the skin, often causing large, red, inflamed welts. This trauma frequently leads to secondary bacterial infections, especially in children who scratch the site.
Wasps and Bees (Hymenoptera)
These produce an immediate painful sting followed by localised swelling and erythema. In sensitised individuals, however, stings may trigger systemic allergic reactions ranging from generalised urticaria to life threatening anaphylaxis.
Ticks
Ticks in Ireland are key vectors for Lyme disease, making prompt, safe removal vital. Patients should inspect the knees, groin, armpits, and scalp after outdoor activity. Use a tick tool or fine-tipped tweezers to remove ticks without squeezing the body. Pharmacists should also advise patients to monitor for erythema and systemic flu-like symptoms in the weeks after exposure. While Tick-Borne Encephalitis is not established in Ireland, travelers hiking in endemic areas of mainland Europe or Scandinavia should consider vaccination.
Allergic Reactions: Local Versus Systemic
One of the most important roles of the pharmacist is differentiating a benign localised reaction from a potentially dangerous systemic allergy.
Large Local Reactions are common and may continue to expand over 24 to 48 hours, sometimes exceeding 10 cm in diameter. Although uncomfortable, they are generally not predictive of future anaphylaxis.
Red flags requiring urgent GP or emergency assessment include generalized hives, facial swelling, respiratory distress (wheeze, dyspnoea, throat tightness), dizziness, or collapse. Seek immediate care for persistent vomiting, abdominal pain, or infection signs like fever and rapidly spreading cellulitis. Patients with respiratory or cardiovascular compromise must be treated for potential anaphylaxis and receive adrenaline therapy promptly.
The Noble False Widow Spider and its myths and misconceptions
Public concern regarding spiders has grown, particularly toward the Noble False Widow. Social media fuel anxiety despite the low medical risk. Bites are often compared to wasp stings, usually causing localised redness and swelling that settle with conservative management.
Pharmacists should note that a minority may experience pronounced swelling, limb stiffness, or nausea. Rarely, secondary infections or complications requiring hospital assessment occur. Importantly, Ireland has no “deadly” spiders and many presumed “bites” are actually other insect bites or skin infections.
Practical Advice and OTC Management
Prevention advice includes using insect repellents containing DEET (N,N-diethyl-meta-toluamide), Icaridin or PMD (p-menthane-3,8-diol), wearing long sleeves and tucking trousers into socks in tick-prone areas, avoiding bright floral clothing and strong perfumes, and keeping sugary drinks covered when outdoors, particularly for those in higher-risk environments such as farming or rural settings.
For most insect bites and stings, treatment focuses on symptomatic relief and prevention of secondary infection.
To relieve symptoms and prevent infection, cold compresses to reduce swelling and discomfort, use oral non-sedating antihistamines to improve pruritic and swelling and add topical antipruritic preparations such as crotamiton or calamine and advice to avoid scratching to reduce the risk of secondary infection.
Role of Specialist Allergy Assessment
While most reactions can be safely managed in primary care or pharmacy settings, selected patients benefit from specialist allergy evaluation.
With growing interest in beekeeping and increasing awareness of the potentially serious stings associated with the Asian hornet, concerns around venom allergy are also rising. While the current risk in Ireland remains low, this species is now well established in countries including France, Spain, Portugal, Belgium and Italy, making this particularly relevant for Irish travellers and individuals who have experienced systemic reactions following bee or wasp stings.
In our clinical practice, we provide diagnostic testing for Hymenoptera venom allergy, including testing relating to the Asian hornet, helping identify those at higher risk of severe allergic reactions. Where appropriate, patients can also be equipped with emergency medication, including adrenaline auto-injectors.
Conclusion
Community pharmacists occupy a central role in the management of insect bites and stings. Their contribution extends beyond symptomatic treatment to include early recognition of systemic allergic reactions, identification of tick-borne disease risk, prevention counselling, and patient reassurance.
As outdoor activity continues to increase during the Irish summer season, maintaining a balanced approach between clinical vigilance and public reassurance remains essential.
