What is the management and treatment for a bee allergy?

Management and Treatment of Bee Allergy

For anaphylaxis from bee stings, immediately administer intramuscular epinephrine 0.01 mg/kg (up to 0.3 mg) in children or 0.3-0.5 mg in adults into the anterolateral thigh—this is the only first-line treatment and must never be delayed for antihistamines or corticosteroids. 1, 2

Immediate Sting Site Management

Remove the stinger within 60 seconds by any method available—scraping or plucking both work equally well, but speed is critical as venom continues to deliver for up to 60 seconds. 1

• The method of removal does not affect the size of the reaction; only the time the stinger remains embedded matters 1
• Wash the area with soap and water after stinger removal 1
• Stings to the eye itself (not eyelid) require immediate evaluation by a trained medical professional due to risk of permanent vision loss 1

Treatment Based on Reaction Severity

Local Reactions (Pain, Swelling, Itching at Sting Site)

• Apply ice or cold packs for local pain relief 1
• Administer oral antihistamines (over-the-counter) to alleviate local itching 1
• Apply topical corticosteroids directly to the sting site for local itching and inflammation 1
• Give acetaminophen or NSAIDs for pain relief 1
• Do NOT prescribe antibiotics—the swelling is allergic inflammation, not infection 1

Large Local Reactions (Swelling Extending Beyond Sting Site, Peaking at 24-48 Hours)

• Initiate a short course of oral corticosteroids promptly within the first 24-48 hours to limit progression of extensive swelling 1
• Continue topical corticosteroids, oral antihistamines, and cold compresses as above 1
• These reactions are IgE-mediated and occur in 5-15% of the population 1

Anaphylaxis (Life-Threatening Emergency)

Epinephrine is the ONLY appropriate first-line treatment—antihistamines and corticosteroids play NO role in acute anaphylaxis management and must never delay epinephrine administration. 1, 2

• Administer epinephrine 0.01 mg/kg (maximum 0.3 mg) in children or 0.3-0.5 mg in adults intramuscularly in the anterolateral thigh 2
• Activate emergency medical services immediately 1
• Be prepared to repeat epinephrine if symptoms persist or recur 1
• Signs of anaphylaxis include: difficulty breathing, tongue/throat swelling, lightheadedness, vomiting, disseminated hives, laryngospasm, bronchospasm 1, 2
• Laryngeal edema is the most common cause of death from bee sting-induced anaphylaxis 1
• Approximately 40-60 deaths occur annually in the United States from sting-induced anaphylaxis 1

Long-Term Management and Prevention

Epinephrine Autoinjector Prescription

All patients who experience anaphylaxis from bee stings must be prescribed an epinephrine autoinjector with instructions for self-administration at the first sign of systemic reaction. 1

• Patients should self-administer the autoinjector if anaphylaxis occurs 1
• First aid providers should assist with autoinjector use if the patient requires help 1

Allergy Evaluation and Venom Immunotherapy (VIT)

Refer all patients with systemic anaphylactic reactions to an allergist-immunologist for venom-specific IgE testing and consideration of venom immunotherapy. 1

• VIT is highly effective at preventing future life-threatening reactions and should be considered for patients with history of systemic reactions 1
• VIT reduces the risk of future anaphylaxis from 30-60% down to less than 5% 1
• Treatment typically continues for 3-5 years 1
• Baseline serum tryptase measurement is an important predictor of reaction severity, VIT response, and relapse risk 1
• Patients taking antihistamines before venom injections have fewer adverse effects and may have improved outcomes 1

Special Considerations

• Bumblebee venom allergy is usually distinct from honeybee venom allergy and requires specific testing 1
• Patients with mastocytosis (found in 3-5% of sting anaphylaxis patients) are prone to very severe reactions 1
• Beta-blockers and ACE inhibitors may increase risk of severe reactions in patients with insect sting allergy 1
• Multiple stings (typically >20 from large hornets or >100 from honeybees) can cause toxic reactions from massive envenomation even in non-allergic individuals 1

Critical Pitfalls to Avoid

• Never delay epinephrine in anaphylaxis to give antihistamines or corticosteroids first—this can be fatal 1, 2
• Do not prescribe antibiotics for swelling—this is allergic inflammation, not infection 1
• Failing to prescribe epinephrine autoinjectors to patients with systemic reactions leaves them vulnerable to fatal outcomes 1
• Failing to refer patients with anaphylaxis for allergy evaluation and VIT consideration misses the opportunity to prevent future life-threatening reactions 1