From the Guidelines
The recommended treatment for bug bites typically involves washing the affected area with soap and water, then applying an over-the-counter hydrocortisone cream (0.5-1%) up to four times daily for 1-3 days to reduce inflammation and itching, as suggested by the practice parameter update 2011 1. For pain and swelling, taking an oral antihistamine like diphenhydramine (Benadryl) 25-50mg every 4-6 hours or a non-sedating option like cetirizine (Zyrtec) 10mg once daily can be beneficial. Some key considerations for treatment include:
- Cold compresses applied for 15-20 minutes several times a day can help reduce swelling and numb the area.
- Avoid scratching to prevent infection.
- For severe reactions with extensive swelling, difficulty breathing, or signs of infection (increasing redness, warmth, pus), seeking medical attention immediately is crucial. These treatments work by reducing the body's histamine response to the proteins in bug saliva that cause the itching and inflammation, as noted in the management of acute reactions to stings 1. Most bug bites will resolve within a few days with these simple interventions. It's also important to note that for patients with a history of severe insect sting reactions, referral to an allergist-immunologist for skin testing or in vitro testing for specific IgE antibodies to insects may be necessary, as highlighted in the practice parameter update 2011 1.
From the FDA Drug Label
Uses temporarily relieves itching associated with minor skin irritations, inflammation, and rashes due to: ... insect bites Directions for itching of skin irritation, inflammation, and rashes: adults and children 2 years of age and older: apply to affected area not more than 3 to 4 times daily The recommended treatment for bug bites is to apply hydrocortisone to the affected area not more than 3 to 4 times daily for adults and children 2 years of age and older, to temporarily relieve itching associated with minor skin irritations and inflammation 2 2.
- For children under 2 years of age, ask a doctor.
- For children under 12 years of age with external anal and genital itching, ask a doctor 2.
From the Research
Bug Bite Treatment
The recommended treatment for bug bites varies depending on the severity of the reaction.
- For simple insect bites, there is a lack of evidence for the efficacy of treatments, and recommendations are based on expert opinion and clinical experience 3.
- Antihistamines and topical corticosteroids are available over the counter (OTC) in the UK, but their effectiveness is not well-established 3.
- In cases of allergic reactions, adrenaline may be used as a treatment, possibly supplemented with antihistamine and corticosteroid 4.
- For massive local reactions and urticaria, antihistamines are often sufficient 4.
- Hyposensitization with insect venom preparations can eliminate the future risk of systemic insect sting reactions 4.
Prevention and Management
- Prevention of mosquito bites is key, using physical barriers or chemical repellents 5.
- Treatment of mosquito bite reactions consists of second-generation antihistamines and topical corticosteroids 5.
- Further research is needed on topical treatments that target neural-mediated itch 5.
- In general practice, antibiotics are often prescribed for insect bites, but this may contribute to antimicrobial resistance, and patients could make more use of antihistamines for itch before consulting 6.
Allergic Reactions
- Insect stings are an important cause of anaphylaxis, and anaphylaxis can also occur from insect bites, although this is less common 7.
- Diagnostic and management strategies for patients allergic to insect bites are less developed than those for insect stings 7.
- Effective methods to diagnose insect sting allergy and assess risk of future sting reactions have been developed, and management strategies using insect avoidance measures, self-injectable epinephrine, and allergen immunotherapy are very effective in reducing insect-allergic patients' risk of reaction from future stings 7.