Treatment for Wasp Bites
For wasp bites, treatment should focus on cold compresses, oral antihistamines, elevation of the affected area, and monitoring for signs of anaphylaxis, which requires immediate epinephrine administration. 1
Initial Assessment and Management
Local Reactions (Most Common)
- Apply cold compresses to the affected area to reduce local pain and swelling
- Elevate the affected area to minimize swelling
- Use oral antihistamines for itching and discomfort
- Consider topical lidocaine for pain relief if skin is intact 1
- Monitor the bite site for 48-72 hours for signs of infection or progression 1
Pain Management
- Use over-the-counter acetaminophen or NSAIDs for pain relief
- Recent research shows that concentrated heat application may provide rapid relief from pain and itching after insect bites, with one study showing pain reduction within 2 minutes and near-complete relief within 10 minutes 2, 3
Severe Reactions
Anaphylaxis Management (Emergency)
- Anaphylaxis requires immediate treatment with epinephrine, which is FDA-approved for emergency treatment of allergic reactions to insect stings 4
- Administer epinephrine intramuscularly into the anterolateral thigh:
- Adults and children ≥30 kg: 0.3-0.5 mg (0.3-0.5 mL)
- Children <30 kg: 0.01 mg/kg (0.01 mL/kg), up to 0.3 mg 1
- Delay in epinephrine administration has been associated with fatal sting reactions 1
- After initial treatment, transport the patient to an emergency department for monitoring and supportive care 1
Multiple Stings
- Multiple wasp stings (>10) require close monitoring as they can lead to systemic toxicity
- In severe cases with numerous stings, patients may develop intravascular hemolysis, rhabdomyolysis, acute renal failure, and other complications 5
- Early medical intervention with alkaline diuresis and intensive supportive care improves outcomes in cases of multiple stings 5
Infection Management
- Antibiotics are not routinely needed for early, uninfected insect bites
- If signs of infection develop, consider antibiotics such as:
- Cephalexin: 250 mg four times daily
- Clindamycin: 300-400 mg three times daily (for penicillin-allergic patients)
- Amoxicillin-clavulanate: 875/125 mg twice daily 1
- Infected wounds should not be closed to prevent further complications 1
Prevention and Follow-up
- Wear protective clothing (long sleeves, pants, closed shoes) in areas where wasps may be present
- Apply DEET-containing repellents (10-30% concentration) to skin and clothing 1
- Patients with a history of systemic reactions should be referred to an allergist for evaluation for venom immunotherapy and should carry injectable epinephrine 1
- Follow-up within 24 hours either by phone or office visit is advised for significant reactions 1
Important Considerations
- Systemic allergic reactions to insect stings occur in 0.4-0.8% of children and up to 3% of adults, usually within 10 minutes of the sting 1
- Large local reactions peak at 24-48 hours and may last over a week 1
- Death from wasp stings is typically due to anaphylactic reactions in sensitized individuals rather than direct toxicity (except in cases of multiple stings) 6