What is the treatment for an allergic reaction to a bee sting?

Treatment for Allergic Reactions to Bee Stings

For allergic reactions to bee stings, immediate administration of epinephrine via autoinjector is the first-line treatment for anaphylaxis, while local reactions can be managed with stinger removal, antihistamines, corticosteroids, and pain relievers. 1

Anaphylactic Reactions

Immediate Management

• Self-administer epinephrine autoinjector or assist the person in using it if they're experiencing anaphylaxis (difficulty breathing, tongue/throat swelling, lightheadedness, vomiting, widespread hives) 1
• Activate emergency response system immediately for any person experiencing anaphylaxis 1
• Delayed use of epinephrine can lead to fatal outcomes, making prompt administration critical 1
• The recommended dose is 0.01 mg/kg (up to 0.3 mg) in children and 0.3-0.5 mg in adults, depending on reaction severity 1
• Intramuscular injection in the anterolateral thigh achieves faster and higher plasma concentrations than subcutaneous or arm injections 1
• Repeat epinephrine dosing may be required for persistent or recurrent symptoms 1
• Antihistamines and corticosteroids are not substitutes for epinephrine in anaphylaxis 1, 2

Follow-up Care

• Monitor for biphasic reactions (recurrence without re-exposure) for 4-12 hours, depending on risk factors 2, 3
• Refer to an allergist-immunologist for evaluation and consideration of venom immunotherapy 1
• Patients with history of systemic reactions should carry emergency epinephrine and be trained in its use 1
• Consider medical identification bracelet or necklace 1

Local Reactions

Immediate Management

• Remove stinger as soon as possible by plucking or scraping (method doesn't matter, but speed does) 1
• Wash the area with soap and water 1
• Apply ice or cold packs to reduce pain and swelling 1
• Take over-the-counter oral antihistamines to alleviate itching 1
• Apply topical corticosteroids to reduce itching 1
• Use over-the-counter acetaminophen or NSAIDs for pain relief 1

Large Local Reactions

• For extensive swelling that persists for several days, oral antihistamines and cold compresses are helpful 1
• A short course of oral corticosteroids may be beneficial for severe swelling 1
• Antibiotics are usually not necessary as the swelling is from allergic inflammation, not infection 1

Special Considerations

Stings to the Eye

• Any sting to the eye itself (not just eyelid) requires immediate evaluation by a medical professional due to risk of permanent vision loss 1

Toxic Reactions

• Multiple stings (typically >100) can cause toxic reactions due to massive envenomation 1
• Toxic reactions may be clinically indistinguishable from allergic reactions 1

Prevention Strategies

• Have known nests removed by professionals 1
• Avoid bright clothing, flowery prints, and scented products 1
• Wear protective clothing (long pants, sleeves, closed shoes) when outdoors 1
• Be cautious near bushes, eaves, garbage containers, and picnic areas 1
• Avoid eating or drinking outdoors when possible 1

Common Pitfalls to Avoid

• Delaying epinephrine administration in anaphylaxis - this is associated with fatal outcomes 1, 2
• Relying solely on antihistamines or corticosteroids for anaphylaxis treatment 1, 2
• Failing to remove the stinger quickly, allowing continued venom release for up to 60 seconds 1
• Mistaking large local allergic reactions for infection and unnecessarily prescribing antibiotics 1
• Discharging patients too soon after anaphylaxis without monitoring for biphasic reactions 2, 3
• Not referring patients with systemic reactions to an allergist for proper evaluation and management 1