What is the recommended treatment for a bee sting without anaphylaxis?

Treatment of Bee Stings Without Anaphylaxis

For bee stings without anaphylaxis, immediate removal of the stinger by either scraping or pinching, followed by washing the area with soap and water, applying ice or cold packs, and using over-the-counter medications for symptom relief is the recommended treatment approach. 1, 2

Immediate Management

1. Stinger Removal

   • Remove the stinger as soon as possible - the method doesn't matter (scraping or pinching) 1, 3, 4
   • Speed of removal is more important than technique, as venom delivery continues for up to 60 seconds while the stinger remains embedded 1, 3
   • For honeybee stings specifically, the barbed stinger often remains in the skin and should be removed promptly 1

2. Wound Cleaning

   • Wash the area with soap and water 1, 2
   • This helps reduce the risk of secondary infection

Symptom Management

For Pain Relief

• Apply ice or cold packs to the sting site 1, 2
  • Use a thin barrier between ice and skin to prevent cold injury 2
• Take over-the-counter pain medications:
  • Acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen 1, 2
  • Topical 2.5% lidocaine ointment may be applied cautiously for local pain relief 2

For Itching Relief

• Use over-the-counter oral antihistamines 1
• Apply topical corticosteroids 1

Special Considerations

• Eye Stings: Stings to the eye itself (not just eyelid) require immediate medical evaluation due to risk of permanent vision loss 1

• Monitoring for Complications: Watch for signs of:

  • Secondary infection (increasing redness, warmth, pain, purulent drainage) 2
  • Delayed allergic reactions
  • Monitor the site for 48-72 hours 2

When to Seek Medical Attention

Seek immediate medical care for:

• Multiple stings (especially >10) 2
• Signs of infection 2
• Stings inside mouth or throat 2, 5
• Development of systemic symptoms (even if not full anaphylaxis) 2

Prevention Strategies

• Wear protective clothing (long sleeves, pants) during outdoor activities 2
• Avoid bright colors and strong scents that attract bees and wasps 2
• Use DEET-containing insect repellents (10-30%) 2
• Use screens on windows and doors 2

Important Clinical Pearls

• The American Heart Association guidelines emphasize that the speed of stinger removal is more important than the method used 1, 4
• Contrary to popular belief, pinching to remove a stinger does not increase envenomation compared to scraping, as long as removal is prompt 3, 4
• For patients with known insect sting allergies, referral to an allergist for evaluation and possible venom immunotherapy should be considered, even if the current sting did not cause anaphylaxis 2, 6
• While most bee sting reactions are local and self-limiting, it's important to note that a previous mild reaction does not predict the severity of future reactions 7