What is the treatment for a bee sting?

Treatment for Bee Stings

The immediate treatment for a bee sting should focus on quick removal of the stinger (regardless of method), followed by local wound care and monitoring for signs of allergic reaction. 1, 2

Immediate Management

1. Remove the stinger immediately

   • Quick removal is more important than the method used 2
   • Can be scraped or pinched off, as envenomation increases with time the stinger remains in the skin

2. Local wound care

   • Clean the wound thoroughly with soap and water 1
   • Apply a cold compress to reduce pain and swelling 1
   • Consider topical corticosteroids for inflammation 1
   • Topical lidocaine may help relieve local pain 1

3. Symptomatic relief

   • Over-the-counter acetaminophen or NSAIDs for pain relief 1
   • Oral antihistamines for itching 1
   • Concentrated heat application can rapidly reduce inflammation, pain, and itching within 2-5 minutes 1

Management of Reactions

Local Reactions (Most Common)

• Small area of pain, redness, and swelling at the sting site
• Usually self-limiting and resolve within hours without treatment 3
• For large local reactions, a brief course of oral corticosteroids may be recommended 1

Systemic Allergic Reactions (Anaphylaxis)

• Immediate administration of epinephrine is crucial for anaphylaxis 1, 4

  • Adult dose: 0.3-0.5 mg intramuscularly into anterolateral thigh 1
  • Children ≥30 kg: 0.3-0.5 mL intramuscularly into anterolateral thigh 1
  • Delay in epinephrine administration has been associated with fatal outcomes 1

• Monitor for signs of anaphylaxis 4:

  • Flushing, apprehension, syncope
  • Tachycardia, hypotension
  • Respiratory symptoms (airway swelling, laryngospasm, bronchospasm)
  • Gastrointestinal symptoms (vomiting, diarrhea, abdominal cramps)
  • Skin manifestations (pruritus, urticaria, angioedema)

• Anaphylactic reactions typically occur within 10 minutes of the sting 3

• Patients with anaphylaxis should be monitored closely as symptoms may recur 4

Special Considerations

Multiple Stings

• The estimated lethal dose from massive envenomation is approximately 20 stings/kg 3
• Aggressive supportive care is needed for multiple stings

Oropharyngeal Stings

• Can produce life-threatening airway obstruction due to localized swelling 5
• Even with minimal initial symptoms, parenteral treatment with epinephrine, steroids, antihistamines, and inhalational bronchodilators is recommended 5
• Immediate endotracheal intubation and mechanical ventilation for at least 24 hours should be considered for patients with signs of airway compromise 5

Follow-up Care

• Monitor the sting site for 48-72 hours for signs of infection 1
• Patients with a history of systemic reactions should:
  • Be referred to an allergist-immunologist for evaluation 1
  • Carry self-injectable epinephrine and know how to use it 1
  • Consider obtaining medical identification jewelry 1
  • Be educated on insect avoidance measures 1

Prevention

• Avoid brightly colored clothing and strong-smelling materials 1
• Wear protective clothing 1
• Apply DEET-containing repellents (10-30% concentration) to skin and clothing 1
• Remove nests and avoid areas with high grass and weeds 1