What is the recommended dosage of Benadryl (diphenhydramine) for a bee sting?

Diphenhydramine Dosage for Bee Sting Treatment

For a bee sting, the recommended dosage of diphenhydramine (Benadryl) is 25-50 mg orally every 4-6 hours for adults and children over 12 years of age, and 25 mg for children 6-12 years of age. 1, 2

Initial Management of Bee Stings

Immediate Actions

• Remove the stinger as quickly as possible by either scraping or pinching it out - the method doesn't matter as much as speed of removal 3, 1
• Wash the area with soap and water 1
• If the sting is to the eye, seek immediate medical evaluation 1

Local Reaction Management

• For local itching:
  • Oral diphenhydramine (Benadryl) 25-50 mg every 4-6 hours for adults and children over 12 years 1, 2
  • For children 6-12 years: 25 mg every 4-6 hours 2
  • Do not use in children under 6 years of age 2
  • Do not exceed 6 doses in 24 hours 2
• Additional treatments for local symptoms:
  • Topical corticosteroids can help alleviate itching 1
  • Over-the-counter pain relievers like acetaminophen or NSAIDs may be used for pain 1
  • Ice or cold packs can provide local pain relief 1

Important Considerations

Anaphylaxis Recognition and Management

• If signs of anaphylaxis develop (difficulty breathing, throat swelling, lightheadedness, vomiting, widespread hives), this is an emergency 1
• Epinephrine is the drug of choice for anaphylaxis, not antihistamines 1
• Activate emergency response system immediately if anaphylaxis occurs 1
• Antihistamines like diphenhydramine should never be used alone to treat anaphylaxis but are considered second-line therapy to epinephrine 1

Limitations of Diphenhydramine

• While diphenhydramine is commonly used, it has significant side effects including sedation and potential cardiac toxicity in overdose 4
• Second-generation antihistamines may be preferable for some patients due to fewer side effects 4
• In anaphylaxis management, a combination of diphenhydramine and ranitidine is superior to diphenhydramine alone 1

Special Populations

• Children under 6 years: Do not use diphenhydramine without medical supervision 2
• Patients with a history of severe systemic reactions to insect stings should:
  • Carry epinephrine for emergency self-treatment 1
  • Consider venom immunotherapy after appropriate testing 1, 5
  • Be educated about insect avoidance strategies 1

Pitfalls to Avoid

• Do not delay removal of the stinger - the amount of venom delivered corresponds directly to how long the stinger remains in the skin 1, 3
• Do not rely solely on antihistamines for treating anaphylaxis - epinephrine is the first-line treatment 1
• Do not exceed the recommended maximum dose of diphenhydramine (no more than 6 doses or 300 mg in 24 hours for adults) 2
• Be aware that patients on beta-blockers or ACE inhibitors may be at increased risk for more severe reactions to insect stings 6