What are the clinical treatment guidelines for an Apis (Honey Bee) sting?

From the Guidelines

For a bee sting, immediate removal of the stinger by scraping it off and administration of first aid as per the 2024 American Heart Association and American Red Cross guidelines is crucial. The guidelines recommend that if a person experiences anaphylaxis due to a bee, wasp, or hornet sting and an epinephrine autoinjector is available, the person should self-administer the autoinjector 1.

First Aid Measures

• Remove the stinger as soon as possible by plucking or scraping, as recommended by the guidelines 1.
• Wash the area with soap and water to prevent infection.
• Apply a cold compress for 10-20 minutes to reduce swelling and pain.
• For local itching, over-the-counter oral antihistamines or topical corticosteroids can be used 1.
• For pain relief, administration of over-the-counter acetaminophen and nonsteroidal anti-inflammatory agents may be considered, or ice or cold packs may be applied 1.

Anaphylaxis Treatment

• If anaphylaxis occurs, immediate use of an epinephrine autoinjector is recommended, followed by activation of the emergency response system 1.
• People with known bee allergies should carry an epinephrine auto-injector and use it immediately if stung, then proceed to emergency care even if symptoms improve 1.
• The recommended dose of epinephrine is 0.01 mg/kg, up to 0.3 mg in children, and 0.3 to 0.5 mg in adults, depending on the severity of the reaction 1.

Special Considerations

• Stings to the eye should be evaluated by a trained medical professional 1.
• Patients with a history of severe allergic reactions or those at high risk should discuss the need to carry injectable epinephrine with their physician 1.

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 clinical treatment guidelines for a bee sting include the administration of epinephrine (IM) for emergency treatment of allergic reactions, including anaphylaxis, which may result from insect stings 2.

• The signs and symptoms associated with anaphylaxis include:
  • Flushing
  • Apprehension
  • Syncope
  • Tachycardia
  • Thready or unobtainable pulse associated with hypotension
  • Convulsions
  • Vomiting
  • Diarrhea and abdominal cramps
  • Involuntary voiding
  • Airway swelling
  • Laryngospasm
  • Bronchospasm
  • Pruritus
  • Urticaria or angioedema
  • Swelling of the eyelids, lips, and tongue It is essential to advise patients or their caregivers about common adverse reactions associated with the use of epinephrine and to warn them about the possibility of recurrence of symptoms and the risk of serious skin and soft tissue infections at the injection site 2.

From the Research

Clinical Treatment Guidelines for Bee Stings

• The standard treatments for large local reactions to bee stings include ice, nonsteroidal anti-inflammatory medications, antihistamine medications, and topical or systemic corticosteroids 3.
• However, these treatments do not immediately address the pain associated with the symptoms nor initiate immediate treatment of the allergic and inflammatory response 3.
• A study found that subcutaneous and intradermal injection of 1% lidocaine with epinephrine into the sting area can provide rapid reversal of large local reactions, including pain and edema 3.
• Epinephrine is also used to treat anaphylactic reactions to bee stings, but there is confusion among medical practitioners regarding its indications, dosage, and route of administration 4.
• Multiple doses of epinephrine may be necessary for patients with systemic reactions to bee stings, with 16% of patients receiving more than one dose in one study 5.
• Patients with systemic reactions to bee stings often receive antihistamines, systemic corticosteroids, and epinephrine, and may be discharged with a prescription for self-injectable epinephrine 5.
• Referral to an allergist is often not documented, highlighting the need for improved management of patients with acute anaphylactic reactions to bee envenomation 4, 5.