What is the treatment for honeybee bites?

Treatment of Honeybee Stings

The immediate treatment for honeybee stings involves removing the stinger as quickly as possible (regardless of method), followed by symptomatic management with cold compresses, oral antihistamines, and analgesics for local reactions, while systemic reactions require prompt epinephrine administration and emergency medical attention. 1

Initial Management

Stinger Removal

• Remove the stinger as soon as possible to minimize venom exposure - the method (scraping or pinching) is less important than speed of removal 1, 2
• Wash the area with soap and water after stinger removal 3

Local Reaction Management

• Apply cold compresses or ice to reduce pain and swelling 1
• Use oral antihistamines to reduce itching and pain 1
• Consider oral analgesics (acetaminophen, ibuprofen) for pain relief 3
• For severe local swelling, a short course of oral corticosteroids may be helpful, although definitive evidence from controlled studies is lacking 1
• Antibiotics are usually NOT necessary unless there is evidence of secondary infection 1

Management Based on Reaction Severity

Typical Local Reactions

• Most stings cause transient pain, redness, and swelling that resolve within hours to days 1
• These mild reactions typically require minimal or no treatment 1

Large Local Reactions

• Characterized by extensive swelling extending from the sting site, peaking at 24-48 hours, and lasting 5-10 days 1
• Treatment includes antihistamines, cold compresses, and possibly oral corticosteroids 1
• Risk of future systemic reaction is relatively low (5-10%) 1
• Venom immunotherapy is generally not necessary but may be considered for those with frequent unavoidable exposure 1

Systemic Reactions

• Require immediate treatment with injectable epinephrine for symptoms beyond the skin (respiratory, cardiovascular, gastrointestinal) 1, 4
• Epinephrine should be administered intramuscularly in the anterolateral thigh for optimal absorption 3, 4
• Delay in epinephrine administration is associated with fatal outcomes 1, 3
• Transport to emergency department is essential after epinephrine administration 1
• For patients with history of only cutaneous systemic reactions, initial treatment may include antihistamines and close observation 1

Special Considerations

Eye Stings

• Stings to the eye itself (not just eyelid) require immediate medical evaluation due to risk of permanent vision loss 1, 3

Multiple Stings

• Can cause toxic reactions due to massive envenomation, particularly with >100 stings 3

High-Risk Patients

• Patients with previous severe reactions, mastocytosis, or elevated baseline serum tryptase are at higher risk for severe reactions to future stings 1
• These patients should be referred to an allergist-immunologist for evaluation 1

Long-term Management

Allergy Evaluation

• Patients who have experienced systemic reactions should be referred to an allergist for testing and possible venom immunotherapy 1
• Skin testing or in vitro testing for specific IgE antibodies to insect venom is recommended 1
• Venom immunotherapy significantly reduces the risk of future systemic reactions from 25-70% to approximately 5% 1, 5

Prevention Strategies

• Have known nests removed by professionals 3
• Avoid bright clothing, flowery prints, and scented products 3
• Wear protective clothing when in high-risk areas 3
• Be cautious near bushes, eaves, garbage containers, and picnic areas 3
• Avoid eating or drinking outdoors when possible 3

Pitfalls to Avoid

• Delaying epinephrine administration in anaphylaxis - this is associated with fatal outcomes 1, 3
• Mistaking large local reactions for infection and unnecessarily prescribing antibiotics 1
• Failing to refer patients with systemic reactions to an allergist for evaluation 1
• Focusing on the method of stinger removal rather than speed - quick removal by any method is most important 2