Best Steroid for Bee Stings
Topical corticosteroids are the recommended steroid formulation for treating local itching and inflammation from bee stings, with oral corticosteroids reserved only for severe large local reactions with extensive swelling. 1
Treatment Algorithm Based on Reaction Severity
For Simple Local Reactions (Most Common)
- Apply topical corticosteroids directly to the sting site to alleviate local itching and reduce inflammation 1
- Combine with cold compresses and oral antihistamines for optimal symptom control 1, 2
- Over-the-counter acetaminophen or NSAIDs may be added for pain relief 1
- Antibiotics are NOT indicated - the swelling is allergic inflammation, not infection 1, 3
For Large Local Reactions (>10 cm diameter with extensive swelling)
- Continue topical corticosteroids and antihistamines initially 1, 3
- A short course of oral corticosteroids is effective for limiting severe swelling, particularly when started promptly within the first 24-48 hours 1
- The American Academy of Allergy, Asthma, and Immunology supports oral corticosteroids for severe cases, though acknowledging limited controlled trial data 1, 3
Critical Distinction: Anaphylaxis vs Local Reactions
- Epinephrine is the primary treatment for anaphylaxis (difficulty breathing, throat swelling, lightheadedness, widespread hives), NOT corticosteroids 1, 2
- Corticosteroids play NO role in acute anaphylaxis management - epinephrine must be administered immediately 1, 2
- Even for upper airway stings with significant edema, epinephrine administration is what reverses the swelling, not steroids alone 4, 5
Important Clinical Caveats
Common Pitfall: Mistaking allergic swelling for infection and prescribing antibiotics instead of anti-inflammatory treatment 6, 3. The large swelling occurring in the first 24-48 hours is caused by allergic inflammation and does not require antibiotics 1.
Timing Matters: For large local reactions, prompt initiation of oral corticosteroids within the first day or two is most effective at limiting progression of swelling 1, 3.
Special Situations:
- Corneal bee stings require systemic and local steroids plus antibiotics due to risk of severe intraocular damage 7
- Oropharyngeal stings with airway compromise require parenteral steroids, antihistamines, AND epinephrine, with consideration for intubation 5
Do Not Delay Stinger Removal: Remove the stinger immediately by scraping or plucking, as venom delivery continues for up to 60 seconds - this takes priority over any medication administration for local reactions 1, 6