What is the treatment for an allergic reaction to a bee sting?

Treatment of Allergic Reactions to Bee Stings

Epinephrine is the first-line treatment for systemic allergic reactions (anaphylaxis) to bee stings and should be administered immediately. 1

Types of Allergic Reactions and Their Management

Systemic Allergic Reactions (Anaphylaxis)

• Emergency treatment with injectable epinephrine is essential for anaphylaxis 2, 3
  • Adults and children ≥30 kg: 0.3-0.5 mg (0.3-0.5 mL) intramuscularly into anterolateral thigh
  • Children <30 kg: 0.01 mg/kg (0.01 mL/kg), up to 0.3 mg intramuscularly into anterolateral thigh
  • May repeat every 5-10 minutes as necessary 1
• Delay in epinephrine administration has been associated with fatal sting reactions 2
• After initial treatment, the patient should be transported to an emergency department for further monitoring and supportive care 2
• Common signs and symptoms of anaphylaxis include:
  • Respiratory: airway swelling, laryngospasm, bronchospasm
  • Cardiovascular: hypotension, tachycardia, thready or unobtainable pulse
  • Cutaneous: flushing, pruritus, urticaria, angioedema
  • Gastrointestinal: vomiting, diarrhea, abdominal cramps
  • Other: syncope, convulsions, involuntary voiding 1

Large Local Reactions

• Characterized by extensive swelling surrounding the sting site that can persist for several days
• Treatment options include:
  • Cold compresses to reduce local pain and swelling 2, 3
  • Oral antihistamines for itching and discomfort 2, 3
  • Elevation of the affected area 3
  • In severe cases, a short course of oral corticosteroids 2
  • Antibiotics are usually not necessary unless signs of infection develop 2, 3

Cutaneous Systemic Reactions

• For patients with only cutaneous systemic symptoms (e.g., generalized hives without other systemic symptoms), initial treatment may include antihistamines and close observation 2
• However, vigilance is necessary as these reactions can progress to more severe anaphylaxis

Prevention and Follow-up

Immediate Measures

• Remove the stinger (if present) as quickly as possible by scraping it off with a fingernail or card edge
  • Note: Honeybees typically leave a barbed stinger with attached venom sac in the skin, but other stinging insects may also leave stingers 2

Long-term Management

• Patients with a history of systemic reactions to insect stings should:
  • Be referred to an allergist for evaluation 2, 3
  • Carry injectable epinephrine for emergency use 2, 3
  • Consider venom immunotherapy (VIT), which can significantly reduce the risk of future systemic reactions 2

Special Considerations

Risk Factors for Severe Reactions

• Previous systemic reaction to an insect sting increases risk for subsequent reactions (25-70% risk) 2
• Patients taking ACE inhibitors may experience more severe allergic reactions to bee stings 4
• Beekeepers may develop tolerance after multiple stings but can still experience allergic reactions, particularly after the first stings of the season 2

Unusual Presentations

• Delayed allergic reactions, including serum sickness, can occur 1-2 weeks after a sting 5
• In rare cases, severe reactions may not present with typical cutaneous symptoms 6
• Severe cases unresponsive to conventional treatment may require advanced interventions, though these are extremely rare 6

Prevention Strategies

• Wear long sleeves, long pants, and closed shoes in high-risk areas
• Apply DEET-containing repellents (10-30% concentration)
• Avoid areas with high uncut grass, weeds, and low brush, especially during warm months 3

Remember that prompt recognition and treatment of allergic reactions to bee stings, particularly with epinephrine for anaphylaxis, is crucial for preventing serious outcomes and potential fatalities.