What over-the-counter (OTC) medication can be used to treat throat numbness caused by a bug bite?

OTC Medication for Throat Numbness from Bug Bite

For throat numbness following a bug bite, immediately take oral diphenhydramine (Benadryl) 25-50 mg and seek emergency medical evaluation, as throat symptoms indicate potential airway involvement requiring urgent assessment for anaphylaxis. 1, 2

Immediate Action Required

Throat numbness is a warning sign of upper airway involvement and potential anaphylaxis, not a simple local reaction. 1

• Upper airway symptoms including throat itching, throat tightness, and throat numbness indicate systemic allergic reaction requiring immediate intervention 1
• Laryngeal edema is the most common cause of death from insect sting-induced anaphylaxis 1
• Fatal sting reactions are strongly associated with delay in appropriate treatment 3, 1

OTC Treatment Approach

Oral antihistamines are the appropriate OTC medication for throat symptoms, but they are adjunctive only—not primary treatment for anaphylaxis: 1, 2

• Diphenhydramine (Benadryl) 25-50 mg orally is the recommended OTC antihistamine for allergic reactions to insect bites 1, 4
• H1 antihistamines help with itching and mild allergic symptoms but do NOT treat life-threatening airway compromise 1
• Second-generation antihistamines (cetirizine, loratadine, fexofenadine) are alternatives but are less sedating and may be less effective for acute reactions 5, 6

Critical Distinction: Local vs. Systemic Reaction

You must differentiate between a simple local reaction and systemic involvement:

• Local reactions cause transient swelling at the bite site lasting up to several days and can be managed with topical corticosteroids, cold compresses, and oral antihistamines 3, 2, 7
• Throat numbness indicates systemic reaction involving mucous membranes beyond the bite site, which requires emergency evaluation 1
• Oral and nasal mucosa showing itching, swelling, or numbness are signs of anaphylaxis, not simple local reaction 1

When Epinephrine is Required (Not OTC)

If throat numbness is accompanied by ANY of the following, this is anaphylaxis requiring immediate intramuscular epinephrine 0.3-0.5 mg (not an OTC medication): 1

• Difficulty breathing, chest tightness, wheeze, or stridor 1
• Hoarseness or voice changes 1
• Lightheadedness, dizziness, or feeling faint 1, 2
• Widespread hives beyond the bite site 1
• Facial swelling extending beyond the sting site 1

Management Algorithm

Follow this sequence:

1. Take oral diphenhydramine 25-50 mg immediately 1, 4
2. Call emergency services or go to the emergency department for evaluation of throat symptoms 1
3. Do NOT rely on antihistamines alone if throat symptoms worsen or breathing difficulty develops 1
4. Remove the stinger immediately by scraping or flicking if still present, as venom delivery continues for up to 60 seconds 2, 7
5. Apply cold compresses to the bite site to reduce local swelling 2, 7

Common Pitfalls to Avoid

• Do not assume throat numbness is a minor symptom—it indicates mucous membrane involvement and potential airway compromise 1
• Do not delay seeking medical evaluation while waiting for antihistamines to work, as fatal reactions are associated with treatment delay 3, 1
• Do not use topical antihistamines or corticosteroids for throat symptoms—these are only for local skin reactions 2, 7
• Do not take antibiotics—swelling from insect bites is allergic inflammation, not infection 2, 7

Follow-Up Care

After the acute episode resolves, you should: 3, 1

• Be referred to an allergist-immunologist for venom-specific IgE testing 3, 1
• Obtain a prescription epinephrine autoinjector (EpiPen) for future reactions 3, 1
• Consider venom immunotherapy, which reduces future systemic reaction risk from 30-60% to less than 5% 3, 1
• Carry medical identification for insect sting hypersensitivity 3