What is the clinical treatment guideline 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. It is also recommended that a first aid provider should assist a person experiencing anaphylaxis to use the autoinjector if assistance is required, and the emergency response system should be activated 1.

Key Recommendations

• Remove the stinger as soon as possible by plucking or scraping, as this can be beneficial 1.
• Wash the area of the bee, wasp, or hornet sting with soap and water 1.
• Over-the-counter oral antihistamines can be used to alleviate local itching, and topical corticosteroids can be used for the same purpose 1.
• Administration of over-the-counter acetaminophen and nonsteroidal anti-inflammatory agents may be considered to alleviate local pain, and ice or cold packs may be applied for local pain relief 1.

Anaphylaxis Treatment

For individuals with known bee allergies, carrying an epinephrine auto-injector (EpiPen) and using it immediately if stung, followed by emergency medical care, is essential 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.

General Care

Most bee stings resolve within hours to days with proper first aid measures. However, it is crucial to seek immediate medical attention if signs of a severe allergic reaction (anaphylaxis) occur, including difficulty breathing, swelling of the face/throat, dizziness, rapid heartbeat, nausea, or hives beyond the sting site. Stings to the eye should be evaluated by a trained medical professional 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 guideline for a bee sting is emergency treatment with epinephrine (IM), specifically for anaphylaxis resulting from allergic reactions to insect stings, including bee 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 seek medical attention immediately if symptoms of anaphylaxis occur after a bee sting.

From the Research

Clinical Treatment Guideline for Bee Sting

• The clinical treatment guideline for a bee sting involves the use of epinephrine, particularly for patients with a history of bee sting allergy or those who experience systemic reactions 3.
• Venom immunotherapy (VIT) is also a recommended treatment, as it not only decreases the risk of anaphylaxis and death but also improves quality of life by reducing anxiety and depression, especially in female subjects 4.
• For patients with systemic reactions, antihistamines and systemic corticosteroids may also be administered in addition to epinephrine 3.
• In some cases, patients may require more than one dose of epinephrine, and physicians should consider prescribing two doses of self-injectable epinephrine for patients at risk for systemic reactions 3.
• Referral to an allergist is also important, although it is often underdocumented, with only 11% of patients receiving documentation of referral to an allergist in one study 3.

Treatment Options

• Epinephrine: used to treat systemic reactions, including anaphylaxis 3.
• Venom immunotherapy (VIT): used to decrease the risk of anaphylaxis and death, and to improve quality of life by reducing anxiety and depression 4.
• Antihistamines: used to treat systemic reactions, in addition to epinephrine 3.
• Systemic corticosteroids: used to treat systemic reactions, in addition to epinephrine 3.
• Self-injectable epinephrine: prescribed for patients at risk for systemic reactions, with consideration for prescribing two doses 3.