From the Guidelines
Management for a yellow jacket sting involves prompt removal of the stinger, cleaning the area with soap and water, and applying a cold compress to reduce swelling and pain, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. The following steps can be taken to manage a yellow jacket sting:
- Remove the stinger as soon as possible by plucking or scraping it off the skin, as this can be beneficial in reducing the amount of venom injected 1.
- Clean the area with soap and water to prevent infection.
- Apply a cold compress for 10-15 minutes to reduce swelling and pain.
- Over-the-counter pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) can help manage discomfort.
- For itching and inflammation, take an antihistamine such as diphenhydramine (Benadryl) 25-50 mg every 4-6 hours or cetirizine (Zyrtec) 10 mg daily.
- Apply a topical hydrocortisone cream (0.5-1%) to the sting site 2-3 times daily to reduce inflammation.
- Elevate the affected area if possible. Most yellow jacket stings resolve within a few days with these measures. However, it is essential to seek immediate medical attention if signs of a severe allergic reaction (anaphylaxis) occur, such as difficulty breathing, swelling of the face or throat, dizziness, rapid heartbeat, or hives spreading beyond the sting site. People with known severe allergies to insect stings should carry an epinephrine auto-injector (EpiPen) and use it immediately if symptoms of anaphylaxis develop, followed by emergency medical care, as emphasized in the guidelines 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. The management for a yellow jacket sting includes emergency treatment with epinephrine (IM) for anaphylaxis, which may result from an allergic reaction to the sting. Key signs and symptoms that may require this treatment include:
- Flushing
- Apprehension
- Syncope
- Tachycardia
- Hypotension
- Convulsions
- Airway swelling
- Laryngospasm
- Bronchospasm
- Pruritus
- Urticaria or angioedema 2
From the Research
Management of Yellow Jacket Stings
The management of yellow jacket stings involves understanding the potential for anaphylactic reactions and taking appropriate measures to prevent and treat them.
- Patients with a history of insect sting anaphylaxis and positive venom skin tests should have epinephrine available and are candidates for subsequent venom immunotherapy, which provides almost 100% protection against subsequent re-sting reactions 3.
- The severity of anaphylactic reactions after a sting challenge correlates significantly with age and the time interval between sting challenge and onset of anaphylaxis 4.
- A single negative sting challenge response may not be used to select patients for venom immunotherapy, as 21% of patients who showed no clinical response to a first sting challenge had anaphylactic responses after a second sting challenge 5.
Factors Influencing Sting Challenge Outcomes
Several factors influence the outcome of sting challenge studies, including:
- The species of insect used, with Vespula maculifrons causing more systemic reactions than Vespula germanica 6.
- Patient characteristics, such as a severe history of previous reactions and positive venom skin tests at <1.0 microg/mL 6.
- The time of year, with no difference found in sting outcome and venom-induced histamine release between insects collected in July or October 6.
Treatment of Yellow Jacket Stings
Treatment of yellow jacket stings typically involves conservative therapy, such as: