What is the treatment for a wasp sting?

Treatment for Wasp Stings

For a typical wasp sting, treatment should include immediate cleaning with soap and water, application of a cold compress to reduce pain and swelling, and use of oral analgesics such as acetaminophen for pain control. 1

Initial Management

1. Clean the sting site thoroughly:

   • Wash with soap and water
   • Perform irrigation with normal saline if available 1

2. Reduce pain and swelling:

   • Apply a cold compress or ice pack to the area (place a thin barrier between ice and skin) 1
   • Consider topical 2.5% lidocaine ointment for local pain relief 1
   • Use oral acetaminophen for pain control 1

3. Manage local reactions:

   • Elevate the affected limb if significant swelling is present 1
   • Antihistamines may help reduce itching and swelling 1, 2
   • Topical corticosteroid lotions can help with inflammation 2

Severe Reactions Management

For patients experiencing anaphylaxis (a life-threatening emergency):

1. Administer epinephrine immediately:

   • Epinephrine (IM) is the first-line treatment for anaphylaxis resulting from insect stings 3
   • Signs of anaphylaxis include flushing, syncope, tachycardia, hypotension, airway swelling, bronchospasm, urticaria, and angioedema 3

2. Monitor vital signs and be prepared to provide additional supportive care:

   • Onset of anaphylactic signs typically occurs within 10 minutes of the sting 2
   • Prompt recognition and treatment is critical for successful management 2

Special Considerations

• Patients with history of systemic reactions should:

  • Carry self-injectable epinephrine and know how to use it 1
  • Consider obtaining medical identification jewelry 1
  • Be referred to an allergist-immunologist for evaluation 1
  • Consider venom immunotherapy (VIT) if they have positive specific IgE tests 1

• Multiple stings can lead to more severe reactions including:

  • Vomiting, diarrhea, dyspnea, generalized edema, hypotension 4
  • Rarely, serious complications like stroke and multi-organ dysfunction 4
  • The estimated lethal dose is approximately 20 stings/kg in most mammals 2

When to Seek Medical Attention

• Immediate medical attention is required for:

  • Signs of anaphylaxis (difficulty breathing, throat tightness, dizziness, widespread hives)
  • Multiple stings, especially in children, elderly, or those with underlying health conditions
  • Stings in the mouth, throat, or eyes

• Follow-up care should be considered:

  • Monitor the bite site for 48-72 hours for signs of infection 1
  • Follow-up within 24-48 hours to assess response to treatment 1
  • Watch for signs of secondary infection (increasing redness, warmth, pain, purulent drainage) 1

Prevention

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

Clinical Pearls

• Unlike bees, wasps can sting multiple times as they do not lose their stinger 2
• Anaphylactic reactions to stings are not dose-dependent or related to the number of stings 2
• Mastocytosis is found in 3-5% of patients with sting anaphylaxis, making these patients prone to very severe reactions 5
• Most patients with systemic anaphylactic reactions to wasp stings need specific immunotherapy to prevent future reactions 5