What is the treatment for swelling after a bee sting?

Treatment for Swelling After a Bee Sting

For swelling after a bee sting, treatment should include removing the stinger, applying cold compresses, taking antihistamines, using topical corticosteroids, and elevating the affected area. In severe cases or signs of anaphylaxis, immediate administration of epinephrine is critical 1.

Initial Management

1. Remove the stinger immediately (if still present)

   • Scrape it off with a flat-edged object like a credit card
   • Avoid using tweezers which may squeeze more venom into the skin

2. Reduce local swelling

   • Apply cold compresses or ice packs for 20 minutes at a time
   • Elevate the affected limb if possible to reduce swelling 2
   • Clean the area with mild soap and water

Medication Options

For Mild to Moderate Local Reactions

• Oral antihistamines (such as diphenhydramine/Benadryl)
• Topical corticosteroid creams to reduce inflammation
• Over-the-counter pain relievers (acetaminophen or ibuprofen) for pain management

For Severe Local Reactions

• Oral corticosteroids may be prescribed for extensive swelling
• H1 and H2 blockers in combination may provide better relief

Emergency Treatment for Anaphylaxis

Anaphylaxis requires immediate medical attention. Signs include:

• Difficulty breathing
• Swelling of face, lips, tongue
• Dizziness or fainting
• Rapid heartbeat
• Nausea, vomiting, or diarrhea

Emergency treatment includes:

• Epinephrine (adrenaline) - immediate intramuscular injection is the first-line treatment for anaphylaxis resulting from allergic reactions to insect stings 1
• Airway management - in cases of oropharyngeal stings with airway compromise, endotracheal intubation may be necessary 3
• Systemic corticosteroids
• Antihistamines
• Inhalational bronchodilators

Special Considerations

• Monitor for at least 24 hours after significant reactions, as delayed reactions can occur
• Orofacial bee stings require special attention due to risk of airway obstruction, even with initially minimal symptoms 3
• Multiple stings (estimated lethal dose: approximately 20 stings/kg) can cause severe reactions even in non-allergic individuals 2
• Rare complications can include deep vein thrombosis 4 and eosinophilic cellulitis (Wells syndrome) 5, which may require specific treatments

Prevention of Future Reactions

• For patients with history of severe reactions, consider referral for allergy testing
• Venom immunotherapy (desensitization) may be recommended for those with severe systemic reactions 6
• Advise patients with known bee sting allergies to carry emergency epinephrine auto-injectors
• Recommend protective clothing when outdoors in areas where bees may be present

When to Seek Medical Attention

Advise patients to seek immediate medical care if:

• Signs of anaphylaxis develop
• Swelling continues to worsen after 48 hours
• Signs of infection appear (increasing pain, redness, warmth, pus)
• Swelling affects the face, mouth, or throat
• Multiple stings are received, especially in children or elderly patients