What is the recommended treatment in the ER for a non-anaphylactic wasp sting?

Treatment of Non-Anaphylactic Wasp Stings in the ER

For non-anaphylactic wasp stings, the recommended treatment in the emergency room includes removal of any remaining stinger, application of cold compresses, and pain management with oral analgesics. 1, 2

Initial Assessment and Management

1. Confirm non-anaphylactic status:

   • Verify absence of systemic symptoms such as difficulty breathing, hypotension, or widespread hives
   • Continue to monitor for delayed reactions (though most severe reactions occur soon after envenomation) 1

2. Remove any remaining stinger or venom sac:

   • Lift or scrape off the stinger if present (unlike bees, wasps typically don't leave stingers behind)
   • Avoid squeezing the site, which may introduce more venom 2

3. Local wound care:

   • Clean the area with mild soap and water
   • Apply cold compresses to reduce pain and swelling 1, 2

Pain Management

• First-line: Over-the-counter analgesics such as acetaminophen or NSAIDs for pain relief 2
• Topical options: Consider topical lidocaine cream or gel (4-5% formulation) to reduce pain 1
• Avoid: Topical aspirin paste is not recommended as research shows it does not reduce swelling or pain and may actually increase the duration of redness 3

Additional Measures

• Antihistamines: Oral antihistamines may help reduce itching and local inflammation 2
• Elevation: Elevate the affected limb if possible to minimize swelling
• Monitoring: Observe for at least 1-2 hours to ensure no progression to systemic symptoms 1, 2

When to Consider Additional Treatment

• Large local reactions: For significant swelling extending beyond the sting site, consider oral corticosteroids 2
• Secondary infection: Monitor for increasing redness, warmth, swelling, or purulence which may indicate infection requiring antibiotics 2
• Tetanus prophylaxis: Not routinely needed for simple wasp stings unless tetanus vaccination is not current 2

Discharge Instructions

• Continue cold compresses at home for the first 24 hours
• Take oral antihistamines and analgesics as needed
• Return if symptoms worsen, spread beyond the local area, or if signs of infection develop
• For patients with large local reactions, follow-up is recommended if symptoms don't improve within 2-3 days 2

Important Considerations

• Avoid common pitfalls:

  • Do not apply heat to wasp stings (unlike jellyfish stings where hot water immersion is beneficial) 1
  • Do not use topical aspirin paste, which has been shown to be ineffective and may prolong symptoms 3
  • Do not routinely prescribe antibiotics for uncomplicated stings without signs of infection 2

• Special populations:

  • In immunocompromised patients, consider closer monitoring and lower threshold for antibiotic therapy if infection is suspected 2
  • For patients with a history of large local reactions to stings, consider referral to an allergist for evaluation 2