What is the first aid treatment for a bee sting?

First Aid Treatment for Bee Stings

Remove any visible stinger immediately by scraping or plucking—speed of removal matters more than method—then wash with soap and water, apply ice for pain, and use oral antihistamines or topical corticosteroids for itching. 1

Immediate Stinger Removal (Most Critical Step)

• Remove the stinger as quickly as possible (within seconds if feasible) by either scraping or plucking—the method doesn't matter, only speed does, as venom continues to be delivered for up to 60 seconds after the sting 1, 2
• Studies in humans show no difference in wheal size between scraping versus plucking, but delayed removal (even by a few seconds) directly increases envenomation 1, 2

Common pitfall: The outdated advice to only scrape (never pinch) the stinger wastes precious time and increases venom delivery—just get it out fast by any means 2

Basic Wound Care

• Wash the sting area with soap and water 1
• This simple step helps prevent secondary infection and removes residual venom from the skin surface 1

Symptom Management for Local Reactions

For Pain and Swelling:

• Apply ice or cold packs to the sting site for local pain relief 1
• Consider over-the-counter acetaminophen or NSAIDs (ibuprofen) for pain control 1

For Itching:

• Use over-the-counter oral antihistamines (such as diphenhydramine or cetirizine) 1
• Apply topical corticosteroid cream or ointment to the affected area 1
• These recommendations are extrapolated from mosquito bite data, as specific bee sting trials are lacking, but represent current best practice 1

Recognition of Anaphylaxis (Life-Threatening Emergency)

Immediately activate emergency services (call 911) if any signs of anaphylaxis develop: 1, 3

• Difficulty breathing or throat swelling
• Lightheadedness or syncope (suggesting hypotension)
• Widespread hives (disseminated urticaria)
• Vomiting or diarrhea
• Rapid progression of symptoms 1, 3

Epinephrine Administration for Anaphylaxis:

• If an epinephrine autoinjector is available, the person should self-administer it immediately at the first sign of anaphylaxis 1, 3
• First aid providers should assist with autoinjector use if the person needs help 1
• Epinephrine is the primary life-saving treatment for anaphylaxis—antihistamines alone are insufficient for severe reactions 1, 3
• Approximately 60 deaths occur annually in the United States from bee, wasp, and hornet stings, primarily from anaphylaxis 1

Critical caveat: Delayed epinephrine administration can be fatal—do not wait to see if symptoms improve on their own 4

Special Circumstances Requiring Medical Evaluation

• Any sting to the eye itself (not just the eyelid) requires immediate evaluation by a medical professional due to risk of permanent vision loss 1
• Multiple stings (generally >20 from large hornets or >100 from honeybees) can cause toxic reactions from massive envenomation, even without allergic predisposition 1, 5
• Signs of toxic reaction include confusion, seizures, hypotension, renal failure, and require emergency medical care 6, 5

What NOT to Do

• Do not apply topical aspirin paste—a randomized controlled trial showed it provides no benefit and actually increases duration of redness compared to ice alone 7
• Do not delay stinger removal to find the "proper" scraping tool—use whatever is immediately available 2