What are the treatment options for a bee sting that is still red and swollen 3 days after the incident?

Treatment for Bee Sting Still Red and Swollen After 3 Days

For a bee sting that remains red and swollen after 3 days, treatment should include oral antihistamines, cold compresses, and possibly a short course of oral corticosteroids if the swelling is extensive. 1

Understanding Large Local Reactions to Bee Stings

• Large local reactions to bee stings typically increase in size for 24-48 hours, can extend more than 10 cm in diameter around the sting site, and may take 5-10 days to fully resolve 1
• These reactions are usually IgE-mediated but are almost always self-limited and rarely create serious health problems 1
• The persistent swelling is caused by allergic inflammation, not infection, and therefore does not require antibiotics unless there is evidence of secondary infection 1

Treatment Algorithm for Persistent Bee Sting Reactions

First-Line Treatments

• Remove any remaining stinger as soon as possible by plucking or scraping to minimize venom delivery 1
• Apply cold compresses to the affected area to reduce local pain and swelling 1
• Use over-the-counter oral antihistamines to alleviate itching 1
• Consider over-the-counter acetaminophen or nonsteroidal anti-inflammatory drugs for pain relief 1

For Extensive Swelling (Large Local Reactions)

• Consider a short course of oral corticosteroids to limit swelling, although definitive proof of efficacy through controlled studies is lacking 1
• Continue with cold compresses and oral antihistamines as needed 1
• Wash the area with soap and water to prevent secondary infection 1

When to Seek Medical Attention

• If pain gets worse or lasts more than 10 days 2
• If redness or swelling continues to increase after 3 days 2
• If new symptoms develop, such as fever, increasing pain, or pus formation, which could indicate secondary infection 1, 2
• If any systemic symptoms develop (difficulty breathing, widespread hives, dizziness, nausea, vomiting) 1

Special Considerations

• Antibiotics are NOT indicated unless there is clear evidence of secondary infection (increasing pain, warmth, purulent drainage) 1
• Up to 10% of patients who have had large local reactions might eventually develop a systemic reaction to future stings 1
• If the sting is near the eye or on the eye itself, seek immediate medical evaluation 1
• For patients with a history of large local reactions, it is optional to prescribe injectable epinephrine for use if they experience a systemic reaction in the future 1

Common Pitfalls to Avoid

• Misdiagnosing the swelling as an infection and unnecessarily prescribing antibiotics 1
• Failing to remove the stinger promptly, which can allow continued venom delivery for up to 60 seconds 1
• Not recognizing signs of secondary infection that would require antibiotics 1
• Ignoring symptoms that could indicate a systemic reaction requiring emergency treatment 1
• Using topical antihistamines, which can cause contact sensitization 3

By following this treatment approach, most large local reactions to bee stings will resolve without complications, though they may take up to 10 days to completely disappear 1.