Bee Sting Treatment
For bee stings, quickly remove the stinger by any method available (scraping or pinching), then treat with cold compresses, oral antihistamines, and topical corticosteroids; for severe allergic reactions, administer epinephrine immediately. 1, 2
Immediate Management
Stinger Removal
- Remove the stinger as quickly as possible, regardless of method (scraping or pinching) 1
- Research shows that speed of removal is more important than the method used
- Delayed removal increases envenomation and weal size
Local Reaction Management
- Apply cold compresses or ice to reduce pain and swelling
- Clean the area with mild soap and water
- Consider topical treatments:
- Topical lidocaine for pain relief
- Topical corticosteroid lotions to reduce inflammation 3
- Oral antihistamines can help manage itching and swelling
Severe Allergic Reactions
Anaphylaxis Recognition
Monitor for signs of anaphylaxis, which typically occur within 10 minutes of the sting 3:
- Flushing, apprehension, syncope
- Tachycardia, hypotension
- Respiratory distress (airway swelling, laryngospasm, bronchospasm)
- Urticaria, angioedema, pruritus
- Gastrointestinal symptoms (vomiting, diarrhea, abdominal cramps)
Anaphylaxis Treatment
- Administer epinephrine immediately for anaphylactic reactions 2
- Intramuscular injection is the preferred route
- FDA-approved for emergency treatment of allergic reactions to insect stings
- Position patient recumbent if possible
- Monitor vital signs
- Seek immediate medical attention even after symptoms improve, as recurrence is possible 2
Special Considerations
Patient Education
- Advise patients about possible adverse reactions to epinephrine including:
- Increased heart rate, palpitations
- Sweating, nausea, vomiting
- Dizziness, headache, anxiety 2
Risk Factors and Monitoring
- Patients with diabetes may develop increased blood glucose levels following epinephrine administration 2
- All patients with bee stings should be monitored closely for potential anaphylactic reactions 3
- Multiple stings can cause serious complications including hemolysis, kidney injury, and hepatotoxicity in rare cases 4
Prevention Strategies
- Wear protective clothing (long pants, long sleeves, closed shoes)
- Use insect repellents containing DEET
- Apply permethrin spray on clothing
Pitfalls and Caveats
- Delayed Reactions: Some toxic reactions can manifest weeks after exposure 4
- Recurrence of Symptoms: Patients who respond well to initial treatment may still experience symptom recurrence and should be advised to seek medical attention if symptoms return 2
- Rare Complications: Though uncommon, bee stings have been associated with serious complications including deep vein thrombosis 5, hepatotoxicity 4, and other vascular pathologies
- Monitoring Duration: The majority of Hymenopteran stings are self-limiting and resolve within a few hours, but close observation is still warranted due to the risk of anaphylaxis 3