What is the acute treatment for an acute allergic reaction to a Hymenoptera (bee) sting?

From the Guidelines

For acute bee sting treatment, immediate removal of the stinger by scraping it off and administration of epinephrine via an auto-injector if anaphylaxis occurs is crucial. According to the 2024 American Heart Association and American Red Cross guidelines for first aid 1, if a person experiences anaphylaxis due to a bee sting and an epinephrine autoinjector is available, the person should self-administer the autoinjector. The guidelines also recommend activating the emergency response system if anaphylaxis occurs.

For local reactions, removal of the stinger as soon as possible by plucking or scraping can be beneficial, and over-the-counter oral antihistamines can be used to alleviate local itching 1. Topical corticosteroids can also be used to alleviate local itching. It is reasonable to wash the area of a bee sting with soap and water, and administration of over-the-counter acetaminophen and nonsteroidal anti-inflammatory agents may be considered to alleviate local pain 1.

In cases of anaphylaxis, epinephrine is the drug of choice, and the recommended dose is 0.01 mg/kg, up to 0.3 mg in children, and 0.3 to 0.5 mg in adults, depending on the severity of the reaction 2. Patients allergic to insect venom should carry epinephrine at an appropriate dosage for administration in case of a sting.

Key steps in acute bee sting treatment include:

• Removing the stinger by scraping it off
• Cleaning the area with soap and water
• Applying a cold compress for 10-20 minutes to reduce swelling and pain
• Taking an oral antihistamine to reduce itching and swelling
• Using acetaminophen or ibuprofen for pain relief
• Applying a topical antihistamine cream or calamine lotion to soothe the area
• Elevating the affected limb if possible
• Seeking immediate medical attention if symptoms of anaphylaxis occur.

From the FDA Drug Label

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. For the acute treatment of a bee sting, epinephrine (IM), such as Adrenalin®, is used for the emergency treatment of allergic reactions, including anaphylaxis caused by insect stings.

• The key symptoms that may require treatment with epinephrine include: + Flushing + Apprehension + Syncope + Tachycardia + Hypotension + Convulsions + Vomiting + Diarrhea + Abdominal cramps + Involuntary voiding + Airway swelling + Laryngospasm + Bronchospasm + Pruritus + Urticaria or angioedema + Swelling of the eyelids, lips, and tongue 3

From the Research

Acute Treatment for Bee Stings

• The primary treatment for anaphylaxis caused by a bee sting is the administration of epinephrine, as stated in the studies 4, 5, 6.
• Epinephrine is considered the first-line treatment for anaphylaxis and should be administered intramuscularly as soon as possible after the onset of symptoms 5, 6.
• The use of antihistamines and corticosteroids may be considered as adjunct treatments, but their effectiveness in anaphylaxis management is not as well-established as epinephrine 4, 7.
• Delayed administration of epinephrine is a risk factor for fatal anaphylaxis, highlighting the importance of prompt treatment 7.

Administration of Epinephrine

• Epinephrine should be administered intramuscularly, and the dose should be optimized to ensure effective treatment 5.
• The use of epinephrine auto-injectors can facilitate prompt administration of epinephrine in emergency situations 4, 6.
• Patients who have experienced anaphylaxis should be educated on the proper use of epinephrine auto-injectors and should carry one with them at all times 4.

Supportive Care

• In addition to epinephrine administration, supportive care for the patient's airway, breathing, and circulation is crucial in the management of anaphylaxis 4.
• Patients should be monitored for potential biphasic reactions, which can occur several hours after the initial reaction 4, 7.
• The use of intravenous fluids and other supportive measures may be necessary in some cases, particularly if the patient experiences uncontrolled reactions or requires hospital admission 7.