From the Guidelines
The best initial treatment for a new sting is to remove the stinger as soon as possible by plucking or scraping, wash the area with soap and water, and apply a cold compress to reduce swelling and pain, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1.
General Treatment Measures
For most stings, the following measures can be taken:
- Remove the stinger as soon as possible by plucking or scraping, as this can help reduce the amount of venom injected into the skin 1.
- Wash the area with soap and water to clean it and prevent infection 1.
- Apply a cold compress to reduce swelling and pain 1.
- For pain relief, take over-the-counter medications like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) at recommended dosages.
- Apply a topical antihistamine cream or calamine lotion to reduce itching, or take an oral antihistamine like diphenhydramine (Benadryl) 25-50mg every 4-6 hours as needed.
Anaphylaxis Treatment
However, if the person experiences anaphylaxis due to a bee, wasp, or hornet sting, the person should self-administer an epinephrine autoinjector if available, and the emergency response system should be activated immediately 1. It is also important to note that:
- Stings to the eye should be evaluated by a trained medical professional 1.
- Administration of over-the-counter acetaminophen and nonsteroidal anti-inflammatory agents may be considered to alleviate local pain, and administration of ice or cold packs may be considered for local pain relief 1.
Important Considerations
Most stings resolve within hours to days with these treatments. However, seek immediate medical attention if you experience severe symptoms like difficulty breathing, dizziness, rapid heartbeat, swelling of face or throat, or if you have a known allergy to stings, as these may indicate a dangerous allergic reaction requiring emergency treatment.
From the FDA Drug Label
1 INDICATIONS & USAGE Adrenalin® is available as a single-use 1 mL vial and a multiple-use 30 mL vial for intramuscular and subcutaneous use. Emergency treatment of allergic reactions (Type I), including anaphylaxis, which may result from allergic reactions to insect stings, biting insects, foods, drugs, sera, diagnostic testing substances and other allergens, as well as idiopathic anaphylaxis or exercise-induced anaphylaxis.
The best treatment for a new sting is epinephrine (IM), specifically for emergency treatment of allergic reactions, including anaphylaxis resulting from insect stings 2.
- Key points:
- Epinephrine is used for emergency treatment of allergic reactions
- It is used to treat anaphylaxis resulting from insect stings
- Administered via intramuscular or subcutaneous use
From the Research
Treatment for New Sting
- The best treatment for a new sting is to remove the sting quickly, without concern for the method of removal 3.
- The morphology of the sting suggests that scraping or pinching off the sting has little basis, and what is most important is the speed of removal 3.
- Weal size, and thus envenomisation, increases as the time from stinging to removal of the sting increases, even within a few seconds 3.
- For allergic reactions, including those caused by insect stings, epinephrine is the first-line treatment, and delayed administration can be a risk factor for fatal anaphylaxis 4.
- Antihistamines may also be beneficial in the treatment of anaphylaxis, but corticosteroids should be used with caution as they may increase the need for intravenous fluids and hospital admission 4.
- It is essential to differentiate between mast cell-mediated and non-mast cell-mediated angioedema, as the treatment approaches differ, and epinephrine may be harmful in non-mast cell-mediated cases 5.