What is the treatment for a hornet sting?

Treatment of Hornet Stings

For hornet stings, immediately remove any stinger remaining in the skin by plucking or scraping, then wash the area with soap and water, and manage symptoms with oral antihistamines, topical corticosteroids, pain relievers, and cold compresses. 1

Initial Assessment and Emergency Management

Anaphylaxis Recognition and Management

• If signs of anaphylaxis develop (difficulty breathing, throat swelling, lightheadedness, vomiting, widespread hives), immediate action is required:
  • Self-administer epinephrine via autoinjector if available 1, 2
  • Activate emergency response system immediately 1
  • First aid providers should assist with epinephrine administration if needed 1

Stinger Removal

• Remove any stinger remaining in the skin as soon as possible (within 10-20 seconds if possible) 1
• Both plucking and scraping methods are equally effective 1
• Do NOT squeeze or grasp the venom sac as this can inject more venom 1

Treatment of Local Reactions

Immediate Care

• Wash the sting area thoroughly with soap and water 1
• Apply ice or cold packs to reduce pain and swelling 1

Medication Management

1. For itching:

   • Over-the-counter oral antihistamines 1
   • Topical corticosteroids 1

2. For pain:

   • Over-the-counter acetaminophen 1
   • Nonsteroidal anti-inflammatory drugs (NSAIDs) 1

Special Considerations

• Stings to the eye require evaluation by a medical professional 1
• Large local reactions (extensive swelling lasting several days) may benefit from oral corticosteroids 1
• Monitor for secondary infection, though antibiotics are usually not necessary 1

Monitoring and Follow-up

When to Seek Medical Attention

• Signs of anaphylaxis (as described above)
• Stings to the eye 1
• Multiple stings (20+ from large hornets can cause toxic reactions) 1
• Development of large, spreading reaction that worsens after 24-48 hours
• Signs of infection (increasing redness, warmth, pus)

Long-term Considerations

• Individuals with history of systemic reactions should be referred to an allergist 1, 3
• Those with previous systemic reactions have 25-70% risk of future reactions 1
• Venom immunotherapy may be recommended for those with history of systemic reactions 3

Common Pitfalls to Avoid

• Delaying epinephrine administration in anaphylaxis (associated with fatal outcomes) 1
• Mistaking large local reactions for infection (they're typically allergic inflammation) 1
• Underestimating the seriousness of multiple stings, which can cause toxic reactions even in non-allergic individuals 4
• Failing to recognize that hornets, unlike honeybees, can sting multiple times 1, 4

The 2024 American Heart Association guidelines provide the most current evidence-based recommendations for treating hornet stings, emphasizing prompt stinger removal, basic wound care, and appropriate symptom management, while recognizing the potential for severe reactions requiring emergency intervention 1.