What is the treatment for a bee sting?

Treatment for Bee Stings

For bee stings, immediate removal of the stinger by any method (scraping or pinching) is the most important first step, followed by washing the area with soap and water, and managing symptoms with antihistamines, topical corticosteroids, and pain relievers as needed. 1

Initial Management

For Normal Local Reactions:

1. Remove the stinger immediately

   • Remove as quickly as possible (within seconds) by either scraping or pinching 1, 2
   • Speed of removal is more important than the method used 2
   • Honeybee stingers can continue to deliver venom for up to 60 seconds if left in place 1

2. Clean the area

   • Wash with soap and water 1

3. Manage symptoms

   • For itching:
     • Over-the-counter oral antihistamines 1
     • Topical corticosteroids 1
   • For pain:
     • Over-the-counter acetaminophen or NSAIDs 1
     • Ice or cold packs for local pain relief 1

For Severe Reactions (Anaphylaxis):

Emergency treatment is required if signs of anaphylaxis develop:

• Difficulty breathing
• Tongue or throat swelling
• Lightheadedness
• Vomiting
• Widespread hives

1. Administer epinephrine immediately

   • If available, self-administer epinephrine autoinjector 1, 3
   • First aid providers should assist with autoinjector if needed 1
   • Intramuscular injection in the anterolateral thigh is preferred 1
   • Dose: 0.01 mg/kg in children (up to 0.3 mg) and 0.3-0.5 mg in adults 1

2. Activate emergency response system immediately 1

Special Situations

Eye Stings

• All stings to the eye require immediate professional medical evaluation 1, 4, 5
• Eye stings can lead to permanent vision loss if not properly treated 1
• Complications may include keratouveitis, corneal infiltrates, and endothelial damage 4

Massive Envenomation

• Multiple stings (>20 stings/kg) can cause toxic reactions even in non-allergic individuals 6
• Requires immediate emergency medical attention 1

Important Considerations

• Anaphylactic reactions are not dose-dependent - even a single sting can trigger severe reactions in allergic individuals 6
• Delayed use of epinephrine in anaphylaxis can lead to more serious outcomes or treatment failure 1
• Antihistamines and corticosteroids are not substitutes for epinephrine in anaphylaxis 1
• Rare complications of untreated stings can include skin and soft tissue necrosis 7

Follow-up Care

• Patients who have experienced systemic reactions should be referred to an allergist-immunologist 1
• Those with history of systemic reactions should:
  • Learn sting avoidance techniques
  • Carry emergency epinephrine
  • Consider immunotherapy
  • Consider medical identification jewelry 1

Remember that most bee stings cause only local reactions that resolve within hours, but close monitoring is essential as anaphylactic reactions can develop rapidly and be life-threatening.