In addition to taking account of previous stings and how you reacted, your doctor may do a skin test. A bit of extract is either rubbed into a tiny scratch in the skin or injected. As you might have guessed, the injected (intradermal) test runs some risk of triggering a severe reaction in anyone who is highly allergic to insects.

So it's generally reserved for people who show a negative scratch test but for some reason still seem to be allergic. If either test produces a red welt like a hive or a mosquito bite, that indicates allergy. And the bigger and redder the welt, the more allergic your are.

Like any tests, skin tests for insect allergy aren’t foolproof, but combine with your history, they can be somewhat useful. Surprisingly, four out of ten people with both a history of sting allergy and a positive Skin Tests will never again react to stings or bites in the future.

Once Stung, Twice Shy

You can stay away from insects. The trick is persuading them to stay away from you. You can reduce your chances of a disastrous encounter by following the steps in the accompanying box. Given the numbers and agility of our flying and crawling pests, however, you can't be sure you will never experience a surprise attack.

To be on the safe side, doctors recommend that anyone who has a past allergy to venomous insects and who shows a positive skin test receive immunotherapy (also called hyposensitive or desensitization). Immunotherapy is vaccination against bites and stings.

Starting with a week dose, extracts of insect venom are injected regularly, and increased in strength until you can tolerate the amount expected from a bite or sting. Then you receive regular shots to maintain tolerance – weekly during the insect season (April to October in most places, April to December in the South) and every two or three weeks the rest of the year (Immunotherapy for mosquito bites is fairly successful, but less effective than shots for bee stings).

Immunotherapy with insect venom is fairly safe, even for children. Nevertheless, it's reserved for people prone to severe, life threatening reactions. And since no medical treatment is 100 percent effective, allergist strongly urge allergic people to carry insect sting kits as a backup even if they're receiving immunotherapy.

The kits contain adrenalin and other emergency drugs to stop a reaction. Other doctors go so far as to advise anyone who has suffered even mild symptoms of an allergic reaction to bites or stings to carry the kits. Keep one handy all the time: in your home, in your car and so on.

It's also wise to wear a medical warning tag or bracelet to alert medical personnel that you are indeed allergic to insects. In the event that you pass out or become incoherent after a sting or bite, precious time will be saved. Your symptoms won’t be confused with those of a heart attack of other illness.

The tags also list any other allergies to drugs or foods and are available at your local pharmacy. What realize that even with an insect sting kit tucked away in the picnic basket, anyone who is allergic will still recoil at the sight of a bee or spider. But knowing exactly what to do should take some of the anxiety out of venturing into their domain.