What is the treatment for a bee sting?

Treatment for Bee Stings

For bee stings, immediately remove the stinger as quickly as possible by scraping or plucking it out, then wash the area with soap and water, and manage symptoms with antihistamines, topical corticosteroids, and pain relievers as needed. 1

Initial Management

Stinger Removal

• Remove any visible stinger as quickly as possible (within seconds) to prevent additional venom delivery 1, 2
  • Method of removal (scraping or pinching) is less important than speed of removal 2
  • Honeybee stingers can continue to deliver venom for up to 60 seconds after the sting 1

Cleaning

• Wash the sting area with soap and water 1

Treatment Based on Reaction Severity

1. Local Reactions (most common)

• Characterized by pain, swelling, and itching at the sting site
• Treatment options:
  • For pain relief:
    • Over-the-counter acetaminophen or NSAIDs 1
    • Ice or cold packs applied to the area 1
  • For itching:
    • Oral antihistamines 1
    • Topical corticosteroids 1
  • For large local reactions:
    • Cold compresses 1
    • Short course of oral corticosteroids may be considered for severe swelling 1
    • Note: Antibiotics are usually not necessary as swelling is from allergic inflammation, not infection 1

2. Anaphylactic Reactions (emergency)

• Signs: difficulty breathing, throat swelling, lightheadedness, vomiting, hives
• Immediate actions:
  • If epinephrine autoinjector is available, administer immediately 1, 3
  • Activate emergency response system 1
  • Assist with autoinjector use if needed 1
  • Monitor for biphasic reactions 1

3. Special Situations

Eye Stings

• Stings to the eye itself (not eyelid) require immediate medical evaluation 1, 4, 5
• Can lead to permanent vision loss if not properly treated 1
• May require surgical removal of stinger and specialized treatment 4, 5

Important Considerations

• The risk of anaphylaxis is not related to the number of stings but to individual sensitivity 6
• Fatal reactions are often associated with delayed administration of epinephrine 1
• Multiple stings (20 stings/kg or more) can cause toxicity even in non-allergic individuals 6
• Wasps and hornets can sting multiple times, while honeybees typically leave their stinger 1, 6

Monitoring

• All sting victims should be observed for at least 10 minutes, as anaphylactic reactions typically occur within this timeframe 6
• Patients with good response to initial treatment should still be warned about possible recurrence of symptoms 3

Prevention

• Individuals with history of systemic reactions should consider consulting an allergist for venom immunotherapy evaluation 1
• Those with known severe allergies should carry epinephrine autoinjectors 1, 3