What is the appropriate management for a patient with a bee (Apis mellifera) sting in the foot presenting with edema?

Management of Bee Sting in the Foot with Swelling

For a bee sting in the foot with edema, immediate treatment should include removing the stinger as soon as possible by plucking or scraping, washing the area with soap and water, and applying cold compresses to reduce pain and swelling. 1

Initial Assessment and Management

Immediate Actions

• Remove the stinger promptly by plucking or scraping (method doesn't matter, but speed does) 1
• Wash the area with soap and water 1
• Apply ice or cold packs to reduce local pain and swelling 1

Symptom Management

• For pain relief:
  • Over-the-counter acetaminophen or NSAIDs 1
  • Cold compresses applied to the sting site 1
• For itching:
  • Oral antihistamines 1
  • Topical corticosteroids 1

Recognizing Reaction Types

Local Reaction (Most Common)

• Characterized by:
  • Redness
  • Swelling
  • Pain and itching at the sting site 1
  • Usually self-limiting and resolves within hours

Large Local Reaction

• Characterized by:
  • Swelling >10 cm in diameter around the sting site
  • Progressive increase in size for 24-48 hours
  • Takes 5-10 days to resolve 1
• Management:
  • Symptomatic treatment as above
  • Oral corticosteroids may be used, though definitive evidence of efficacy is lacking 1
  • Antibiotics are NOT indicated unless there is evidence of secondary infection 1

Warning Signs Requiring Medical Attention

Signs of Anaphylaxis

• Difficulty breathing
• Tongue or throat swelling
• Lightheadedness
• Vomiting
• Disseminated hives 1

If any of these signs develop, activate emergency response system immediately 1

Other Concerning Signs

• Progressive or severe swelling that impairs function
• Signs of secondary infection (increasing warmth, redness, tenderness, purulent discharge)
• Persistent symptoms beyond expected timeframe

Special Considerations

Pitfalls to Avoid

1. Misdiagnosing as infection: Swelling from bee stings (even with lymphangitis) is caused by mediator release, not infection. Antibiotics should not be prescribed unless there is clear evidence of secondary infection 1

2. Delayed treatment of anaphylaxis: Although rare, anaphylaxis can be life-threatening and requires immediate epinephrine administration and activation of emergency services 1, 2

3. Missing rare complications: In unusual cases, bee stings can lead to complications such as:

   • Deep vein thrombosis 3
   • Eosinophilic cellulitis (Wells syndrome) 4
   • Hypoglycemia (particularly in diabetic patients) 5

Follow-up

• Most local reactions resolve without specific treatment
• If swelling persists beyond 10 days or worsens despite appropriate management, medical re-evaluation is warranted

For patients with a history of large local reactions, there is a small risk (up to 10%) of developing systemic reactions to future stings 1, but most will only need symptomatic care for future stings.