From the order hymenoptera, the honey bee (Apis mellifera), the European wasp (Vespula germanica) and ants from the genus Myrmecia are important causes of mortality or morbidity. Most often their sting causes a painful local reaction with little systemic effect. However in sensitized individuals these stings can cause severe local and/or generalized allergic reactions, including anaphylaxis. Note Dose-dependent toxicity can sometimes be significant with multiple bee and European wasp stings. Haemolysis, rhabdomyolysis and metabolic derangement may precede clinical deterioration.