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There are two types of IgE-mediated reactions to stinging insects: large local reactions and systemic reactions. Acute management of large local reactions is symptomatic and a patient history of a large local reaction does not indicate need for an epinephrine auto-injector or venom immunotherapy. By contrast, acute management of systemic reactions requires intramuscular epinephrine. Long-term management includes prescribing an epinephrine auto-injector and consideration for venom immunotherapy by a paediatric allergist.