What are the medications for treating a Hymenoptera (bee) sting?

From the Guidelines

For bee sting treatment, the most effective approach is to remove the stinger by scraping it off and cleaning the area with soap and water, followed by the administration of epinephrine via an auto-injector if anaphylaxis occurs, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1.

Initial Treatment

• Remove the stinger as soon as possible by plucking or scraping, as this can be beneficial in preventing further venom injection 1.
• Clean the area with soap and water to reduce the risk of infection.

Symptomatic Relief

• Over-the-counter oral antihistamines, such as Benadryl (diphenhydramine 25-50mg every 4-6 hours) or non-drowsy options like Claritin (loratadine 10mg daily), can be used to alleviate local itching and swelling 1.
• Topical corticosteroids, such as hydrocortisone cream (0.5-1%), can be applied to the sting site 2-3 times daily to decrease inflammation 1.
• For pain relief, acetaminophen (Tylenol, 325-650mg every 4-6 hours) or ibuprofen (Advil/Motrin, 200-400mg every 4-6 hours) can be taken, and cold compresses can be applied for 20 minutes several times daily to reduce swelling 1.

Anaphylaxis Treatment

• If a person experiences anaphylaxis due to a bee, wasp, or hornet sting, they should self-administer epinephrine via an auto-injector if available, and a first aid provider should assist if necessary 1.
• The emergency response system should be activated in cases of anaphylaxis, and stings to the eye should be evaluated by a trained medical professional 1.

Prevention and Education

• People with known severe allergies should carry an epinephrine auto-injector (EpiPen) at all times and be educated on its proper use and administration 1.
• Patients and caregivers of children who have experienced a systemic reaction to an insect sting should be taught how to administer epinephrine and under what circumstances 1.

From the FDA Drug Label

1 INDICATIONS & USAGE Adrenalin® is available as a single-use 1 mL vial and a multiple-use 30 mL vial for intramuscular and subcutaneous use. Emergency treatment of allergic reactions (Type I), including anaphylaxis, which may result from allergic reactions to insect stings, biting insects, foods, drugs, sera, diagnostic testing substances and other allergens, as well as idiopathic anaphylaxis or exercise-induced anaphylaxis.

• Epinephrine (IM) is used for the emergency treatment of allergic reactions, including anaphylaxis caused by insect stings.
• The medication is administered via intramuscular or subcutaneous injection.
• Key symptoms of anaphylaxis that may be treated with epinephrine include flushing, apprehension, syncope, tachycardia, and airway swelling, among others 2.

From the Research

Bee Sting Medications

• The primary treatment for anaphylaxis caused by bee stings is adrenaline (epinephrine) 3, 4, 5.
• Adrenaline is recognized as the only medication documented to prevent hospitalizations, hypoxic sequelae, and fatalities 3.
• β2-adrenergic agonists and glucagon are considered second-line treatments for anaphylaxis, while glucocorticoids and antihistamines are used as third-line treatments 3.
• The use of corticosteroids in the management of anaphylaxis is still a topic of debate, with some studies suggesting they may reduce the length of hospital stay, but there is no consensus on their effectiveness in reducing biphasic anaphylactic reactions 4, 6.
• Antihistamines may have a beneficial effect in the treatment of anaphylaxis, particularly when used in conjunction with epinephrine 4.
• Immunotherapy, whether with venom or whole-body extract, has not been proven to prevent death from a bee sting 7.

Treatment Approaches

• Intramuscular epinephrine is the immediate treatment for all patients with anaphylaxis, while intravenous epinephrine may be used in patients in shock 5.
• Airway obstruction must be recognized, and early intubation may be necessary 5.
• Disposition depends on patient presentation and response to treatment, with mandatory observation periods not necessary due to the unpredictability of biphasic reactions 5.

Medication Administration

• Adrenaline autoinjectors are essential for the treatment of anaphylaxis, and their administration should never be delayed 3.
• The use of prehospital epinephrine has been shown to reduce the likelihood of uncontrolled reactions, receipt of intravenous fluids, and hospital admission 4.
• Prehospital antihistamines may also have a beneficial effect, reducing the likelihood of uncontrolled reactions and hospital admission 4.