What is the treatment for an allergic reaction to a bee sting?

Treatment of Allergic Reaction to Bee Sting

Intramuscular epinephrine is the first-line treatment for allergic reactions to bee stings, especially for systemic reactions, and should be administered promptly in the anterolateral thigh for optimal absorption and effectiveness. 1, 2

Immediate Management Based on Reaction Severity

For Systemic Allergic Reactions (Anaphylaxis)

1. Administer epinephrine immediately

   • Use autoinjectable epinephrine in the anterolateral thigh 1
   • Intramuscular injection achieves more rapid and higher plasma concentration than subcutaneous or arm injection 1
   • Delayed use can lead to more serious anaphylaxis or ineffectiveness 1
   • Repeat dosing may be required for persistent or recurrent symptoms 1

2. Secondary treatments (only after epinephrine)

   • Antihistamines (H1 and H2 antagonists)
   • Corticosteroids
   • Note: These are NOT substitutes for epinephrine 1, 3

3. Supportive care

   • Monitor airway, breathing, and circulation
   • Observe for 4-12 hours for potential biphasic reactions 3

For Local Reactions

1. Remove stinger immediately

   • Speed of removal is more important than method used 4

2. Basic wound care

   • Wash area with soap and water
   • Apply ice or cold packs (with thin barrier between ice and skin)
   • Elevate affected limb if significant swelling is present 4

3. Symptom management

   • Over-the-counter pain medications (acetaminophen or NSAIDs)
   • Oral antihistamines
   • Topical corticosteroids
   • Consider topical 2.5% lidocaine ointment for pain relief 4
   • For large local reactions, subcutaneous/intradermal injection of 1% lidocaine with epinephrine may rapidly reverse symptoms 5

Special Considerations

High-Risk Situations Requiring Immediate Medical Attention

• Multiple stings (especially >10)
• Signs of infection
• History of severe allergic reactions
• Stings inside mouth or throat
• Signs of systemic reaction (difficulty breathing, widespread hives, dizziness)
• Eye stings (risk of permanent vision loss) 4

Infection Management

• Monitor bite site for 48-72 hours for infection signs
• Consider antibiotics for:
  • Immunocompromised patients
  • Asplenic patients
  • Those with advanced liver disease
  • Moderate to severe injuries, especially to hand or face 4

Long-term Management

1. Referral to allergist-immunologist for patients who have experienced systemic reactions 1, 4

2. Patient education

   • Insect avoidance strategies
   • Proper use of epinephrine auto-injector
   • Recognition of anaphylaxis symptoms 1, 4

3. Prevention measures

   • Carry epinephrine auto-injector at all times (compliance is often poor) 6, 7
   • Consider medical identification jewelry
   • Wear protective clothing during outdoor activities
   • Avoid bright colors and strong scents
   • Use DEET-containing insect repellents (10-30%)
   • Remove nests and avoid areas with standing water 4

Common Pitfalls and Caveats

1. Delayed epinephrine administration - This is associated with increased morbidity and mortality. There are no contraindications to epinephrine in anaphylaxis, even in patients with cardiovascular disease 1, 3

2. Relying solely on antihistamines or corticosteroids - These are not substitutes for epinephrine in anaphylaxis 1

3. Poor patient compliance with carrying epinephrine - Less than 30% of patients carry their auto-injector at all times, and only 44% demonstrate proper administration technique 6, 7

4. Waiting for additional symptoms - Many patients incorrectly plan to wait for development of other symptoms after a sting before taking action 6

5. Inadequate education - Thorough and repeated instruction on proper epinephrine administration technique by knowledgeable physicians improves outcomes 6, 7