What is the treatment for a bee sting?

Bee Sting Treatment

For a bee sting, immediately remove the stinger by scraping or pinching (method is less important than speed), then wash with soap and water, and manage symptoms with cold compresses, pain medications, and antihistamines. 1

Immediate Management

1. Remove the stinger immediately:

   • Speed is critical - remove within seconds as stingers can continue to deliver venom for up to 60 seconds 1
   • Either scraping or pinching is acceptable - contrary to older advice, method doesn't matter 2
   • Research shows no difference in response between stings scraped or pinched off after 2 seconds 2

2. Clean the area:

   • Wash with soap and water to prevent secondary infection 1

Managing Local Symptoms

For typical local reactions (pain, swelling, itching):

• Pain relief:

  • Apply ice or cold compresses for 10-15 minutes several times daily 1
  • Take over-the-counter pain medications (acetaminophen or NSAIDs) 1
  • Apply topical lidocaine (4-5%) if skin is intact 1

• Itching and swelling:

  • Use over-the-counter oral antihistamines 3, 1
  • Apply topical corticosteroids (limit use to 1-2 weeks) 1
  • For large local reactions, oral corticosteroids may help limit swelling 3
  • Elevate affected extremity if significant swelling is present 1

Caution: Antibiotics are usually not necessary for typical bee sting reactions, as swelling in the first 24-48 hours is caused by allergic inflammation, not infection 3

Recognizing and Managing Anaphylaxis

Anaphylaxis requires immediate medical attention. Signs include:

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

If anaphylaxis occurs:

1. Administer epinephrine immediately via autoinjector 1, 4
2. Call emergency services (911) 1
3. Fatal sting reactions have been associated with delay in epinephrine administration 3

Epinephrine is indicated for emergency treatment of allergic reactions (Type I), including anaphylaxis from insect stings 4

Special Considerations

• Fire ant stings: These typically cause a sterile pseudopustule within 24 hours. The vesicle should be left intact and kept clean 3

• Monitoring for complications: Watch for signs of infection such as increased redness, swelling, or purulent discharge 1

• Rare complications: In extremely rare cases, untreated bee stings can lead to tissue necrosis 5 or other severe complications

Follow-up Care

• Patients with a history of systemic reactions to insect stings are at increased risk (25-70%) for anaphylaxis with future stings 3

• Consultation with an allergist is recommended for those who have experienced systemic reactions to determine risk and prevention strategies 3

• For those with known allergic reactions, venom immunotherapy (VIT) can significantly reduce the risk of future systemic reactions 3