What are the discharge instructions for a patient with a bee sting?

From the Guidelines

For a patient with a bee sting, the most important step is to remove the stinger immediately if still present by scraping it off with a flat-edged object like a credit card, and then clean the affected area with soap and water and apply a cold compress for 10-15 minutes to reduce swelling and pain, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. To manage the symptoms, patients can take over-the-counter pain relievers like acetaminophen (Tylenol) 500-1000mg every 6 hours or ibuprofen (Advil, Motrin) 400-600mg every 6-8 hours as needed for pain and inflammation. Some key points to consider include:

• Applying hydrocortisone cream 1% to the site 2-3 times daily to reduce itching and swelling
• Watching for signs of a severe allergic reaction including difficulty breathing, hives, swelling of face/throat, dizziness, or rapid heartbeat, which require immediate emergency care
• Most bee stings resolve within a few days, but seeking medical attention if increasing redness, warmth, swelling beyond 2 inches in diameter, or if symptoms worsen after 2-3 days
• People with known bee allergies should follow their emergency action plan and use their prescribed epinephrine auto-injector if needed, as suggested by the practice parameter update 2011 for stinging insect hypersensitivity 1. It is also important to note that patients who have experienced a systemic reaction to an insect sting should be referred to an allergist-immunologist for skin testing or occasionally in vitro testing for specific IgE antibodies to insects, and consider immunotherapy if test results are positive, as recommended by the practice parameter update 2011 for stinging insect hypersensitivity 1.

From the FDA Drug Label

17 PATIENT COUNSELING INFORMATION Advise patients or their caregivers about common adverse reactions associated with the use of epinephrine including an increase in heart rate, the sensation of a more forceful heartbeat, palpitations, sweating, nausea and vomiting, difficulty breathing, pallor, dizziness, weakness or shakiness, headache, apprehension, nervousness, or anxiety These symptoms and signs usually subside rapidly, especially with rest, quiet and recumbent positioning. Warn patients with a good response to initial treatment about the possibility of recurrence of symptoms and instruct patients to obtain proper medical attention if symptoms return

The discharge instructions for a patient with a bee sting include:

• Advising patients to rest, remain quiet, and position themselves in a recumbent manner to help symptoms subside rapidly
• Warning patients about the possibility of recurrence of symptoms and instructing them to obtain proper medical attention if symptoms return 2
• Instructing patients to seek medical care if they develop signs or symptoms of infection, such as persistent redness, warmth, swelling, or tenderness, at the epinephrine injection site 2

From the Research

Discharge Instructions for Bee Sting Patients

Discharge instructions for patients with a bee sting depend on the severity of the reaction. The following are general guidelines:

• For patients with mild reactions, treatment typically includes ice, nonsteroidal anti-inflammatory medications, antihistamine medications, and topical or systemic corticosteroids 3.
• Patients with large local reactions may require subcutaneous and intradermal injection of 1% lidocaine with epinephrine into the sting area to rapidly reverse symptoms of pain and pressure, and to reduce allergic and inflammatory responses 3.
• In cases of multiple bee stings (more than 30), patients are at risk of direct venom toxicity, which can be fatal 4.
• Patients who are asymptomatic or experiencing only pain after an envenomation of 50 or more stings should be hospitalized for 24 hours for observation, especially pediatric patients, older patients, and patients with underlying medical problems 5.
• Patients with severe reactions, including anaphylaxis, require immediate medical attention and may need desensitization, adrenaline, and other emergency treatments 6.

Special Considerations

• Patients with a history of asthma or previous crescendo reactions to bee stings are at higher risk of anaphylaxis and should be desensitized and trained in the emergency use of adrenaline 6.
• Sweat bee stings can cause distinct hypersensitivity reactions that are not associated with reactions to other stinging insects, and currently, there is no reliable antigen available for diagnosing or treating this condition 7.
• Delayed toxic reactions can occur after massive bee envenomation, and patients should be monitored for signs of hemolysis, coagulopathy, thrombocytopenia, rhabdomyolysis, liver dysfunction, and disseminated intravascular coagulation 5.