What is the best treatment for a wasp sting?

Best Treatment for a Wasp Sting

The best treatment for a wasp sting includes thorough cleaning with soap and water, applying a medium-potency topical corticosteroid 2-3 times daily, and using oral antihistamines for itch relief. 1

Immediate Management

1. Clean the wound thoroughly with soap and water to remove potential contaminants 1
2. Apply a medium-potency topical corticosteroid 2-3 times daily to reduce inflammation 1
3. Use oral antihistamines for itch relief:
   • Non-sedating options (daytime): cetirizine or loratadine
   • Sedating options (nighttime): diphenhydramine 1
4. For pain relief:
   • Apply topical lidocaine if skin is intact
   • Take over-the-counter acetaminophen or NSAIDs 1
5. Apply cold compresses (never apply ice directly to skin) 1

Monitoring and Warning Signs

Monitor the sting site for 48-72 hours for signs of infection or progression 1. Seek immediate medical attention if you develop:

• Signs of anaphylaxis: flushing, apprehension, syncope, tachycardia, hypotension, convulsions, vomiting, diarrhea, abdominal cramps, airway swelling, laryngospasm, bronchospasm, pruritus, urticaria, angioedema, or swelling of eyelids, lips, and tongue 2
• Signs of infection: persistent redness, warmth, swelling, or tenderness at the sting site 2
• Increasing redness, warmth, swelling, purulent discharge, worsening pain, fever, or systemic symptoms 1

Special Considerations

Anaphylaxis Management

If signs of anaphylaxis develop, emergency treatment with injectable epinephrine is recommended:

• Adult dosage: 0.3-0.5 mg intramuscularly into anterolateral thigh
• Children ≥30 kg: 0.3-0.5 mL intramuscularly into anterolateral thigh 1, 2

Delay in epinephrine administration has been associated with fatal sting reactions, emphasizing the importance of prompt treatment 1.

Prevention of Future Stings

• Avoid wearing brightly colored clothing or flowery prints
• Avoid using strongly scented materials that might attract insects
• Wear long pants, long-sleeved shirts, socks, and shoes when outdoors
• Avoid walking barefoot or with open shoes
• Remove known nests in the vicinity of home (by trained professionals)
• Avoid areas with high uncut grass, weeds, and low brush
• Be cautious near bushes, eaves, and attics 1

Follow-up Care

• Follow up within 24 hours either by phone or office visit 1
• Patients with a history of systemic reactions to insect stings should be referred to an allergist for evaluation for venom immunotherapy and should carry injectable epinephrine 1

Important Caveats

• Unlike bees, wasps can sting multiple times as they do not lose their stinger 3
• Antibiotics are not routinely needed for early, uninfected insect stings but may be considered if signs of infection develop 1
• Rare complications of wasp stings include skin and soft tissue necrosis 4 and rhabdomyolysis (especially with multiple stings) 5
• Do not pluck or squeeze the stinger if present (more common with bee stings than wasp stings), as this may inject more venom into the wounded site 6