What is the treatment for a wasp sting?

Wasp Sting Treatment

The initial treatment for a wasp sting should include prompt removal of any stinger (if present) within 10-20 seconds by flicking or scraping, washing the area with soap and water, and applying a cold compress to reduce pain and swelling. 1

Immediate Management

1. Remove the stinger (if present - note that unlike bees, wasps can sting multiple times without losing their stinger)

   • Use flicking or scraping motion within 10-20 seconds
   • Avoid squeezing or using tweezers which may inject more venom 1, 2
   • Speed of removal is more important than the method 3

2. Clean the area

   • Wash with soap and water to prevent secondary infection 1

3. Reduce pain and swelling

   • Apply ice or cold compress to the sting site 1
   • Use over-the-counter pain relievers:
     • Acetaminophen or NSAIDs for pain relief 1
     • Topical lidocaine may help relieve local pain if skin is intact 1

4. Control itching and allergic reaction

   • Antihistamines are first-line treatment for hives/urticaria 1
   • Standard doses of non-sedating H1 antihistamines:
     • Cetirizine 10mg once daily
     • Loratadine 10mg once daily
     • Fexofenadine 180mg once daily 1

Monitoring for Complications

Watch for signs of anaphylaxis:

• Flushing, apprehension, syncope
• Tachycardia, hypotension
• Difficulty breathing, airway swelling, laryngospasm
• Vomiting, diarrhea, abdominal cramps
• Urticaria, angioedema, swelling of eyelids, lips, and tongue 4

Emergency treatment for anaphylaxis:

• Administer epinephrine immediately as first-line treatment
  • Adults: 0.3-0.5mg intramuscularly in anterolateral thigh
  • Children: 0.01mg/kg (up to 0.3mg) 1, 4
• Supportive therapy and transport to emergency department 1

Follow-up Care

• Monitor for signs of secondary infection or delayed healing 1
• Reevaluate in 48-72 hours if no improvement 1
• Antibiotics are usually unnecessary unless signs of infection develop 1

Special Considerations

When to seek immediate medical attention:

• Signs of anaphylaxis (as listed above)
• Multiple stings (estimated lethal dose is approximately 20 stings/kg) 5
• Signs of infection (persistent redness, warmth, swelling, or tenderness) 4
• History of severe reactions to insect stings 1

Referral to allergist recommended for:

• Patients who have experienced systemic allergic reaction
• Those who need education about risk of future reactions
• Candidates for venom immunotherapy (VIT) 1
• Patients with mastocytosis (found in 3-5% of patients with sting anaphylaxis) 6

Prevention

• Avoid areas where wasps are commonly found (bushes, eaves, attics, garbage containers)
• Wear protective clothing when outdoors
• Avoid wearing brightly colored clothing or flowery prints
• Have known or suspected nests removed by trained professionals 1

Most wasp stings are self-limiting and resolve within a few hours without treatment, but close monitoring is essential due to the potential for life-threatening anaphylactic reactions 5.