What is the treatment for a bee sting?

Bee Sting Treatment

For a typical bee sting, immediately remove the stinger, wash the area with soap and water, and apply ice to reduce pain and swelling. 1 For severe allergic reactions, administer epinephrine immediately.

Initial Management

For Typical Bee Stings (Non-Allergic Reactions)

1. Remove the stinger as quickly as possible - The speed of removal is more important than the method (scraping or pinching) 1, 2
2. Clean the area thoroughly with soap and water 1
3. Apply ice or cold packs to the sting site (with a thin barrier between ice and skin) to reduce pain and swelling 1
4. Consider over-the-counter medications for symptom relief:
   • Pain medications (acetaminophen or NSAIDs like ibuprofen)
   • Oral antihistamines
   • Topical corticosteroids 1

For Allergic Reactions/Anaphylaxis

1. Administer epinephrine immediately (0.3-0.5 mg IM in adults, 0.01 mg/kg up to 0.3 mg in children) for signs of anaphylaxis 1, 3
2. Place patient on cardiac monitor and establish IV access 1
3. Secondary treatments (not substitutes for epinephrine):
   • H1 antihistamines (diphenhydramine 25-50 mg every 6 hours)
   • H2 antihistamines (ranitidine 150 mg twice daily)
   • Corticosteroids (prednisone 40-60 mg daily for 2-3 days) 1

Monitoring and Follow-up

• Observe patients for at least 4-6 hours after treatment if epinephrine is administered 1
• Monitor for signs of delayed or biphasic reactions 1
• Watch for signs of infection at sting sites 1

Special Situations

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) 1
• Stings to the eye (require immediate medical evaluation due to risk of permanent vision loss) 1, 4

Wound Care and Infection Management

• Clean wound thoroughly and explore for foreign bodies 1
• Consider preemptive antibiotic therapy (3-5 days) for high-risk patients:
  • Immunocompromised individuals
  • Asplenic patients
  • Those with advanced liver disease
  • Moderate to severe injuries, especially to hand or face 1

Prevention and Long-term Management

• Prescribe epinephrine auto-injector (2 doses) for patients who experienced systemic symptoms 1
• Consider referral to allergist-immunologist for patients with systemic reactions 1
• Consider venom immunotherapy (VIT) for patients with history of systemic reactions 1, 5
• Prevention measures:
  • Have known nests removed by professionals
  • Avoid wearing bright colors or flowery prints
  • Wear protective clothing (long pants, long sleeves, closed shoes) 1

Common Pitfalls to Avoid

1. Delaying epinephrine administration in anaphylaxis - epinephrine should be the first-line treatment for anaphylaxis, not antihistamines or steroids 1, 3
2. Focusing on method of stinger removal rather than speed - research shows that quick removal is more important than the technique used 2
3. Failing to observe patients after treatment for possible delayed reactions 1
4. Not recognizing signs of infection - persistent redness, warmth, swelling, or tenderness at the sting site may indicate infection 1, 3
5. Underestimating multiple stings - the estimated lethal dose is approximately 20 stings/kg in most mammals 6

While most bee stings are self-limiting and resolve within hours without treatment 6, proper initial management and recognition of severe reactions can prevent serious complications.