Allergic reactions to insect bites and stings are a common problem and the severity of reactions varies from pronounced local manifestations to anaphylaxis. This review summarizes the data of domestic and foreign literature on insects important from a medical point of view, their place in the classification, risk factors and epidemiology of insect allergy in Russia and the world, gives a brief description of the mechanisms of hypersensitivity to insect allergens. Large (pronounced) local reactions, systemic allergic reactions, systemic toxic reactions and unusual reactions to stings of stinging insects are described. Since practitioners most often face the development of local allergic reactions to stinging insects, the clinical manifestations associated with bites of blood-sucking and biting insects, as well as some contact reactions, are described in detail. The infrequent manifestations of insect allergy to blood-sucking insects, such as papular urticaria, Skiter’s syndrome, and severe local reactions associated with a possible association with the Epstein—Barr virus are described. Diagnosis of patients with insect allergy consists of a history taking, which has its own characteristics; indications for further specific examination to identify causative allergens are systemic reactions to stings of stinging insects. The article describes the main approaches to the treatment and prevention of local and systemic manifestations of insect allergy by a dermatologist. An indication for referral to an allergist-immunologist is the transferred systemic reactions to hymenoptera bites for consultation on providing independent emergency care for subsequent stings and determining the possibility of allergen-specific immunotherapy.