What is the treatment for a bee sting?

Treatment for Bee Stings

The primary treatment for a bee sting includes prompt removal of the stinger (if present), cleaning the wound with soap and water, applying topical corticosteroids, and using oral antihistamines and calamine lotion to reduce inflammation and itching. 1

Initial Management

1. Stinger Removal:

   • Remove the stinger as quickly as possible without concern for the method of removal (scraping or pinching) 2
   • Quick removal is crucial as venom continues to be injected while the stinger remains in the skin

2. Wound Care:

   • Clean the wound thoroughly with soap and water 1
   • Apply cold compress or ice to reduce swelling and pain 1
   • Consider topical corticosteroids to reduce local inflammation 1

3. Symptomatic Relief:

   • Oral antihistamines to reduce itching and inflammation 1
   • Calamine lotion can help soothe the affected area 1
   • Acetaminophen or NSAIDs for pain relief 1

Management Based on Reaction Severity

Local Reactions

• Most bee stings cause only local reactions with erythema, edema, and pain at the sting site 3
• These typically resolve within a few hours without treatment 3
• Monitor the site for 48-72 hours for signs of infection 1

Large Local Reactions

• For significant swelling or discomfort:
  • Consider concentrated heat application 1
  • A brief course of oral corticosteroids may be recommended 1

Systemic Allergic Reactions

• Emergency treatment with epinephrine is crucial for systemic reactions 1, 4
• Adult dosage: 0.3-0.5 mg intramuscularly into anterolateral thigh 1
• Signs of anaphylaxis include flushing, syncope, tachycardia, hypotension, convulsions, vomiting, diarrhea, airway swelling, bronchospasm, and angioedema 4
• After epinephrine administration, monitor for recurrence of symptoms 4
• Patients with diabetes should be aware that epinephrine may increase blood glucose levels 4

Prevention of Secondary Infection

• Monitor for signs of infection:
  • Increasing redness, warmth, pain, and purulent drainage 1
  • Systemic symptoms such as fever or chills 1
• If infection develops, antibiotics may be prescribed:
  • Amoxicillin-clavulanate: 875/125 mg twice daily 1
  • Cephalexin: 250-500 mg four times daily 1
  • Clindamycin: 300-400 mg three times daily (for penicillin-allergic patients) 1

Follow-up Care

• Consider follow-up within 24-48 hours to assess response to treatment for significant reactions 1
• Patients with 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 medical identification jewelry 1
  • Be educated on insect avoidance measures 1
  • Consider venom immunotherapy (VIT) if they have positive specific IgE tests 1

Prevention of Bee Stings

• Use DEET-containing repellents (10-30%) 1
• Wear protective clothing, especially during dusk and dawn 1
• Avoid bright colors and strong scents 1
• Use screens on windows and doors 1
• Avoid areas with standing water and remove nests 1

Important Caveats

• Rare cases of serious skin and soft tissue infections, including necrotizing fasciitis and gas gangrene, have been reported at the injection site following epinephrine injection 4
• Anaphylactic reactions to bee stings are not dose-dependent or related to the number of stings 3
• The majority of bee stings are self-limiting events, but close monitoring is essential as life-threatening anaphylactic reactions can progress rapidly 3