What is the treatment for a wasp sting?

Treatment for Wasp Stings

For wasp stings, remove the stinger quickly if present, clean the area with soap and water, apply ice to reduce swelling, and use over-the-counter pain medications and antihistamines for symptom relief; however, for systemic reactions or anaphylaxis, immediately administer intramuscular epinephrine as the first-line treatment. 1

Initial Assessment and Treatment

Local Reactions (Most Common)

1. Remove stinger (if present) as quickly as possible - the method is less important than speed 1
2. Clean the wound 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. Symptom management:
   • Over-the-counter pain medications (acetaminophen or NSAIDs like ibuprofen)
   • Oral antihistamines for itching
   • Topical corticosteroids for inflammation 1

Systemic Reactions and Anaphylaxis (Emergency)

1. Administer epinephrine immediately via intramuscular injection into the anterolateral thigh:
   • Adults: 0.3-0.5 mg
   • Children: 0.01 mg/kg up to 0.3 mg 1, 2
2. Secondary treatments (should never delay epinephrine):
   • H1 antihistamines
   • H2 antihistamines
   • Corticosteroids 1
3. Monitor patient for at least 4-6 hours after treatment for signs of delayed or biphasic reactions 1

Special Considerations

Large Local Reactions

• May affect up to 25% of the population 3
• Oral antihistamines and oral corticosteroids may help manage symptoms 1
• Generally have a low risk of progressing to systemic reactions 1

Risk Factors for Severe Reactions

• History of previous systemic reactions
• Underlying mastocytosis (found in 3-5% of patients with sting anaphylaxis) 3
• Cardiovascular disease (still should receive epinephrine as benefits outweigh risks) 1

Potential Complications

• Infection at sting sites 1, 2
• Rarely, serious conditions like:
  • Rhabdomyolysis (muscle breakdown) 4
  • Allergic encephalitis 5

Prevention and Follow-up Care

Prevention Strategies

• Have known nests removed by professionals
• Avoid wearing bright colors or flowery prints
• Wear protective clothing (long pants, long sleeves, closed shoes) 1

Follow-up Recommendations

• Patients with history of systemic reactions should:
  • Carry autoinjectable epinephrine
  • Be educated on proper use and indications
  • Be referred to an allergist-immunologist 1
• Consider venom immunotherapy (VIT) for patients with history of systemic reactions and specific IgE to venom allergens 1

Infection Prevention

• Consider preemptive antibiotic therapy (3-5 days) for patients who are:
  • Immunocompromised
  • Asplenic
  • Have advanced liver disease
  • Have moderate to severe injuries, especially to hand or face 1
• Update tetanus prophylaxis if vaccination is not current (within 10 years) 1

Common Pitfalls to Avoid

• Delaying epinephrine administration in anaphylaxis (most critical error)
• Failing to monitor patients after treatment (biphasic reactions can occur)
• Underestimating the potential severity of wasp stings (can be fatal in sensitive individuals)
• Not referring patients with systemic reactions to an allergist for long-term management