What is the management for a yellow jacket bee sting?

Management of Yellow Jacket Bee Stings

The immediate management of a yellow jacket bee sting involves prompt removal of the stinger (if present), cleaning the area with soap and water, and applying cold compresses to reduce pain and swelling. 1, 2

Initial Management

1. Remove the stinger (if present)

   • Remove quickly by any method - scraping or pinching is acceptable 3
   • Speed of removal is more important than method to minimize venom exposure

2. Clean the wound

   • Wash the area thoroughly with soap and water 2
   • This helps prevent secondary infection

3. Reduce pain and swelling

   • Apply cold compresses to the affected area 2
   • Elevate the affected area to reduce swelling 2

Symptom Management

For typical local reactions:

• Pain relief:

  • Over-the-counter acetaminophen or NSAIDs 2
  • Topical lidocaine may help if skin is intact 2

• Itching relief:

  • Oral antihistamines (age-appropriate doses) 2
  • Topical corticosteroids for delayed hypersensitivity reactions 2

Monitoring for Complications

Watch for signs of:

1. Large local reaction

   • Extensive swelling extending from sting site
   • Peaks at 24-48 hours and may last over a week 1
   • Occurs in 5-15% of stings 1
   • Treatment: antihistamines, elevation, cold compresses 2

2. Infection

   • Monitor site for 48-72 hours 2
   • Signs: increasing redness, warmth, swelling, purulence
   • Treatment: antibiotics only if infection develops (not prophylactically)
     • First-line options: cephalexin, clindamycin (if penicillin-allergic), or amoxicillin-clavulanate 2

3. Systemic allergic reaction

   • Occurs in 0.4-0.8% of children and up to 3% of adults 1
   • Usually occurs within 10 minutes of sting 4
   • Signs: flushing, syncope, tachycardia, hypotension, airway swelling, bronchospasm, urticaria, angioedema 5
   • Emergency treatment: epinephrine IM is first-line therapy 5
   • Additional treatments: antihistamines and corticosteroids 2, 4

Prevention of Future Stings

• Wear long sleeves, long pants, and closed shoes 2
• Apply DEET-containing repellents (10-30% concentration) 2
• Avoid areas with high uncut grass, weeds, and brush 2
• Be cautious with food outdoors (attracts yellow jackets) 1
• Yellow jackets are more prevalent in late summer 1

Follow-up Care

• For typical local reactions: no follow-up needed unless complications develop
• For large local reactions: follow-up within 24 hours by phone or office visit 2
• For systemic reactions: refer to an allergist for evaluation for venom immunotherapy 1, 2
• Patients with history of systemic reactions should carry injectable epinephrine 2, 5

Special Considerations

• Yellow jacket identification: typically ground-nesting, attracted to food, more prevalent in late summer 1
• Unlike honeybees, yellow jackets can sting multiple times 4
• Yellow jackets can occasionally leave stingers in the skin (though less common than with honeybees) 1
• The risk of future systemic reactions is higher in patients with severe previous reactions and higher skin test sensitivity 6, 7