What is the treatment for a wasp sting?

Treatment for Wasp Stings

The immediate treatment for a wasp sting involves cleaning the area with soap and water, applying a cold compress with a thin barrier between ice and skin, and using over-the-counter pain relievers such as acetaminophen for symptom relief. 1

Initial Management

For typical wasp stings without allergic reactions:

1. Clean the affected area thoroughly with soap and water 1
2. Apply a cold compress or ice pack with a thin barrier between ice and skin to reduce pain and swelling 1
3. Consider topical 2.5% lidocaine ointment for local pain relief 1
4. Use oral acetaminophen for pain control 1
5. Elevate the affected limb if significant swelling is present 1

Recognizing and Managing Allergic Reactions

Wasp stings can cause allergic reactions ranging from mild to severe anaphylaxis. Unlike bees, wasps can sting multiple times, which increases the risk of severe reactions 2.

Signs of Allergic Reaction:

• Mild to moderate: Widespread hives, swelling beyond the sting site
• Severe (anaphylaxis): Difficulty breathing, dizziness, throat swelling, drop in blood pressure

Management of Allergic Reactions:

• For anaphylaxis: Immediate administration of epinephrine via intramuscular injection is the first-line treatment 3
• Epinephrine is indicated for emergency treatment of allergic reactions including anaphylaxis from insect stings 3
• Seek immediate medical attention for signs of systemic reaction 1

High-Risk Situations Requiring Medical Attention

Seek immediate medical care for:

• Multiple stings (especially >10) 1, 4
• Signs of infection (increasing redness, warmth, pain, purulent drainage) 1
• History of severe allergic reactions to insect stings 1
• Stings inside the mouth or throat 1
• Signs of systemic reaction (difficulty breathing, widespread hives, dizziness) 1, 5
• Development of rhabdomyolysis (muscle pain, dark urine) 6, 4
• Corneal stings (require specialized ophthalmologic care) 7

Wound Care and Infection Prevention

• Monitor the bite site for 48-72 hours for signs of infection 1
• Consider antibiotic therapy for:
  • Immunocompromised patients
  • Those with moderate to severe injuries, especially to the hand or face
  • Signs of secondary infection 1

Antibiotic options if infection develops:

• Amoxicillin-clavulanate: 875/125 mg twice daily
• Cephalexin: 250-500 mg four times daily
• Clindamycin: 300-400 mg three times daily (for penicillin-allergic patients) 1

Prevention Strategies

1. Wear protective clothing (long sleeves, pants) during outdoor activities 1
2. Avoid bright colors and strong scents that attract wasps 1
3. Use DEET-containing insect repellents (10-30%) 1
4. Remove nests and avoid areas with standing water 1
5. Use screens on windows and doors to prevent wasp entry 1

Special Considerations

• For patients with known insect sting allergies:

  • Carry self-injectable epinephrine and know how to use it
  • Consider medical identification jewelry
  • Refer to an allergist-immunologist for evaluation and possible venom immunotherapy 1

• For massive envenomation (multiple stings):

  • Be alert for toxic reactions rather than just allergic responses
  • Monitor for organ dysfunction, particularly acute kidney injury, rhabdomyolysis, hemolysis, and liver injury 4
  • Blood purification therapy may be beneficial for patients with ≥20 stings 4