What is the treatment for a bee sting?

Treatment for Bee Stings

Treat bee stings based on reaction severity: remove the stinger immediately within 60 seconds, apply cold compresses and oral antihistamines for local reactions, give oral corticosteroids for large local reactions, and administer intramuscular epinephrine immediately for any signs of anaphylaxis. 1, 2

Immediate Stinger Management

Speed of removal is the only factor that matters—remove the stinger within the first 60 seconds by any method (scraping or plucking) since venom delivery continues for up to 60 seconds. 1, 3

• The method of removal (scraping versus pinching) makes no difference in envenomation—quick removal is what counts 1, 3
• After removal, wash the area with soap and water 1
• This takes priority over any medication administration for local reactions 4

Treatment Algorithm by Reaction Severity

Local Reactions (Most Common)

For typical local reactions with pain, swelling, and redness at the sting site, use symptomatic treatment without antibiotics. 5, 1

• Apply cold compresses or ice packs to reduce pain and swelling 5, 1, 2
• Give oral antihistamines to reduce itching 5, 1, 2
• Apply topical corticosteroids directly to the sting site for local inflammation and itching 1, 4
• Add oral acetaminophen or ibuprofen for pain relief 1, 4
• Do NOT prescribe antibiotics—the swelling is allergic inflammation, not infection 5, 1, 4

Large Local Reactions

For extensive swelling that persists for several days, initiate oral corticosteroids promptly within the first 24-48 hours to limit progression. 5, 1, 4

• A short course of oral corticosteroids is effective when started early 1, 4
• Continue cold compresses and oral antihistamines as adjunctive therapy 5, 1
• Topical corticosteroids alone are insufficient for severe large local reactions 4

Anaphylaxis (Life-Threatening Emergency)

Immediately administer intramuscular epinephrine 0.3-0.5 mg in adults (0.01 mg/kg up to 0.3 mg in children) into the anterolateral thigh—this is the ONLY first-line treatment for anaphylaxis. 1, 2, 6

• Signs of anaphylaxis include difficulty breathing, throat/tongue swelling, lightheadedness, vomiting, widespread hives, or hypotension 2, 6
• Intramuscular injection in the anterolateral thigh achieves faster and higher plasma concentrations than subcutaneous or arm injections 2
• Antihistamines and corticosteroids are NOT substitutes for epinephrine and play NO role in acute anaphylaxis management 1, 2, 4
• Activate emergency medical services immediately 1, 2
• Be prepared to repeat epinephrine dosing in 10-20 minutes if symptoms persist or worsen 1, 2
• Place the patient in a recumbent position with legs elevated if hypotension develops 2
• Delayed epinephrine administration is associated with fatal outcomes—prompt use is critical 5, 1, 2

Critical Pitfalls to Avoid

• Never delay epinephrine in anaphylaxis to give antihistamines or corticosteroids first—this can be fatal 1, 2, 4
• Don't prescribe antibiotics for swelling—this is allergic inflammation, not bacterial infection 5, 1, 4
• Don't waste time trying to identify whether it was a bee, wasp, or hornet—treat based on clinical presentation 1
• Any sting to the eye itself (not just the eyelid) requires immediate ophthalmologic evaluation due to risk of permanent vision loss from corneal damage, cataracts, or optic neuropathy 1, 2, 7, 8
• Multiple stings (typically >100 or approximately 20 stings/kg) can cause toxic reactions from massive envenomation even in non-allergic individuals, requiring supportive care with attention to airway, blood pressure, and renal function 1, 2, 9, 10

Post-Treatment Management

All patients with systemic reactions must receive an epinephrine autoinjector prescription with training on self-administration before discharge. 1, 2

• Refer patients with anaphylaxis to an allergist for venom-specific IgE testing and consideration of venom immunotherapy, which can reduce the 25-70% risk of future systemic reactions to nearly zero 5, 2
• Warn patients about the possibility of biphasic reactions and instruct them to seek medical attention if symptoms return 6
• Advise patients with diabetes that they may develop increased blood glucose levels following epinephrine administration 6
• Common adverse reactions from epinephrine include increased heart rate, palpitations, sweating, nausea, dizziness, headache, and anxiety, which usually subside rapidly with rest 6