hornet sting

ref; medscape.com

Patients with a previous history of severe local reactions have a 5% chance of anaphylaxis in the future, while those with generalized systemic reactions have 60% chance of anaphylaxis upon future exposure. More recent and more severe previous reactions are associated with increased risk; however, most patients who die of anaphylaxis give no history of prior severe local or generalized reaction.
Finally, patients may present with delayed hypersensitivity reactions. These may be immune-complex mediated (either immunoglobulin M or immunoglobulin G) and may be systemic (serum sickness type) or local (Arthus type).
Presentation usually is within 1 week of envenomation, but often the history of an insect bite or sting is not volunteered by the patient unless the clinician specifically asks.
The symptoms may include fever, arthralgias and myalgias, headache, and general malaise. Signs include rash (either maculopapular or palpable purpura of vasculitis), joint swelling and tenderness with or without effusions, adenopathy, and evidence of glomerulitis or nephrotic syndrome. Necrotizing vasculitis also may be evident