From the Guidelines
To treat a bee sting, removal of the stinger as soon as possible by plucking or scraping is recommended, followed by washing the area with soap and water, and applying over-the-counter oral antihistamines or topical corticosteroids to alleviate local itching and swelling. The treatment approach should prioritize alleviating symptoms while monitoring for signs of anaphylaxis, a severe allergic reaction that requires immediate medical attention 1.
Initial Treatment
- Remove the stinger by scraping it off with a flat-edged object to prevent further venom release.
- Wash the area with soap and water to clean it.
- Apply a cold compress for 10-20 minutes to reduce swelling.
Symptomatic Relief
- For pain and inflammation, consider taking an over-the-counter pain reliever like ibuprofen 200-400mg every 6 hours as needed or acetaminophen 500-1000mg every 6 hours 1.
- Apply hydrocortisone cream (0.5-1%) to the site 2-3 times daily to reduce itching and swelling.
- An oral antihistamine like diphenhydramine 25-50mg every 6 hours can also help with itching and swelling.
Anaphylaxis
- Seek immediate medical attention if symptoms of a severe allergic reaction occur, such as difficulty breathing, dizziness, nausea, swelling of the face or throat, or hives away from the sting site, as these indicate anaphylaxis which requires emergency treatment with epinephrine 1.
- If a person experiences anaphylaxis due to a bee sting and an epinephrine autoinjector is available, the person should self-administer the autoinjector, and the emergency response system should be activated 1.
Special Considerations
- Stings to the eye should be evaluated by a trained medical professional 1.
- Patients with a history of severe allergic reactions should carry epinephrine at an appropriate dosage for administration in case of a sting, and should be taught how to administer it 1.
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 treatment of a bee sting, epinephrine (IM) can be used as an emergency treatment for allergic reactions (Type I), including anaphylaxis.
- The drug is administered via intramuscular use.
- Key symptoms of anaphylaxis that may result from a bee sting include:
- flushing
- apprehension
- syncope
- tachycardia
- hypotension
- convulsions
- vomiting
- diarrhea
- abdominal cramps
- involuntary voiding
- airway swelling
- laryngospasm
- bronchospasm
- pruritus
- urticaria
- angioedema
- swelling of the eyelids, lips, and tongue 2
From the Research
Bee Sting Treatment Overview
- Bee stings can cause allergic reactions, ranging from mild to severe anaphylaxis 3
- Treatment regimens for bee stings include home therapies, over-the-counter medications, prescription medications, and emergency treatments 3
Anaphylaxis Treatment
- Epinephrine is universally recommended as the first-line therapy for anaphylaxis, and early treatment is critical to prevent a potentially fatal outcome 4
- Antihistamines are more commonly used to treat patients with anaphylaxis, but they do not relieve or prevent all of the pathophysiological symptoms of anaphylaxis 4
- Corticosteroids may be used in anaphylaxis management, but their role is not well established 5, 6
Management of Allergic Reactions
- An acute allergic reaction is a rapid-onset, IgE-mediated hypersensitivity reaction that can range from mild urticaria and swelling to respiratory collapse 5
- Guidelines for managing allergy and anaphylaxis with epinephrine, corticosteroids, and antihistamines are available, and education, avoidance, and venom-specific immunotherapy are discussed 3, 5
Specific Considerations
- Massive bee stings can cause toxic effects, including tachycardia, elevated creatinine, or rhabdomyolysis, and require evaluation and observation for anaphylaxis and serial laboratory values 7
- Prehospital treatment with epinephrine, antihistamines, and/or corticosteroids can impact anaphylaxis management, and early use of epinephrine and antihistamines may be beneficial 6