From the Guidelines
To treat a wasp sting, immediate removal of the stinger by plucking or scraping is recommended, followed by washing the area with soap and water, as suggested by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. The treatment approach should prioritize alleviating local symptoms while being vigilant for signs of anaphylaxis, a severe allergic reaction that requires immediate medical attention.
- Removal of the stinger as soon as possible can be beneficial, as it may reduce the amount of venom injected into the skin 1.
- Washing the area with soap and water is a reasonable step to take after a sting, as it can help clean the area and potentially reduce the risk of infection 1.
- For local itching, over-the-counter oral antihistamines or topical corticosteroids can be used, as they can help alleviate itching and reduce inflammation 1.
- Administration of over-the-counter acetaminophen or nonsteroidal anti-inflammatory agents may be considered for local pain relief, and applying ice or cold packs can also be beneficial for pain management 1.
- It is crucial to monitor for signs of anaphylaxis, such as difficulty breathing, dizziness, rapid heartbeat, swelling of the face or throat, or hives spreading beyond the sting site, and to seek immediate medical attention if these symptoms occur, as anaphylaxis requires emergency treatment with epinephrine 1.
- If a person experiences anaphylaxis due to a wasp sting and an epinephrine autoinjector is available, they should self-administer the autoinjector, and a first aid provider should assist if necessary, followed by activation of the emergency response system 1.
From the FDA Drug Label
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. For the treatment of a wasp sting, epinephrine (IM) may be used in cases of anaphylaxis, which can result from an allergic reaction to the sting. The key signs and symptoms that may indicate the need for epinephrine treatment include:
- Flushing
- Apprehension
- Syncope
- Tachycardia
- Hypotension
- Convulsions
- Airway swelling
- Laryngospasm
- Bronchospasm
- Pruritus
- Urticaria or angioedema 2
From the Research
Wasp Sting Treatment Overview
- Wasp sting treatment depends on the severity of the reaction, ranging from supportive care for mild reactions to intramuscular epinephrine and adjunct measures for anaphylaxis 3.
- For patients with a history of anaphylaxis, venom immunotherapy is the most effective long-term management, reducing the risk of sting anaphylaxis by up to 98% 3.
Anaphylaxis Treatment
- Treatment of anaphylaxis due to wasp stings involves intramuscular epinephrine, recumbent posture, and adjunct measures such as IV fluids and oxygen 3, 4.
- Carefully titrated intravenous adrenaline combined with volume resuscitation is an effective strategy for treating sting anaphylaxis, with consideration for additional treatment with atropine in cases of severe bradycardia 4.
Special Considerations
- Transient coagulopathy may occur in wasp sting anaphylaxis, presenting with a deranged coagulation profile and normal platelet count, which can aid in diagnosis 5.
- Wasp sting-related allergic encephalitis is a rare condition that may require treatment with intravenous methylprednisolone and intravenous immunoglobulin 6.
- Patients with systemic reactions may require multiple doses of epinephrine, and physicians should consider prescribing two doses of self-injectable epinephrine for those at risk 7.