What medications should be given for a bee sting when away from a hospital, assuming the person has no known severe allergy?

Medications for Bee Stings Away from Hospital (No Known Severe Allergy)

For a simple bee sting in a person without known severe allergy, immediately remove the stinger by any quick method, then treat with oral antihistamines for itching and cold compresses for pain and swelling—no prescription medications are needed for uncomplicated local reactions. 1

Immediate First Steps

• Remove the stinger within seconds by scraping or flicking it away; do not waste time worrying about technique, as speed of removal matters far more than method 2, 3
• Pinching and pulling is acceptable—the old advice to only scrape is outdated, and any delay in removal increases venom injection 3
• Apply cold compresses immediately to the sting site to reduce local pain and swelling 1, 4

Medication Management for Local Reactions

Over-the-Counter Medications (First-Line)

• Oral antihistamines (e.g., diphenhydramine, cetirizine, loratadine) to reduce itching, pain, and inflammation 1, 4
• Oral analgesics (acetaminophen or NSAIDs) for pain relief 4, 5
• Topical corticosteroid cream or lotion applied directly to the sting site for local itching and inflammation 5

What NOT to Use

• Do not use antibiotics—the swelling is allergic inflammation from mediator release, not infection 1, 4, 5
• Antibiotics should only be considered if clear signs of secondary bacterial infection develop (progressive redness, purulent discharge, fever, increasing pain after initial improvement) 1, 4

Management of Large Local Reactions

If extensive swelling develops over 24-48 hours:

• Continue oral antihistamines and cold compresses 1, 4
• Elevate the affected limb if swelling is significant 1
• Consider a short course of oral corticosteroids (e.g., prednisone) for severe swelling, particularly if started within the first 24-48 hours 1, 5
• Large local reactions typically peak at 24-48 hours and resolve over 5-10 days 1

Critical Warning Signs Requiring Emergency Care

Monitor closely for systemic reactions and seek immediate emergency care if any of these develop:

• Urticaria (hives) beyond the sting site 1
• Angioedema (swelling of face, lips, tongue) 1
• Respiratory symptoms (wheezing, throat tightness, difficulty breathing) 1, 6
• Cardiovascular symptoms (dizziness, hypotension, chest pain) 1
• Gastrointestinal symptoms (nausea, vomiting, abdominal cramping) 1

If any systemic symptoms occur, epinephrine 0.3-0.5 mg intramuscularly in the anterolateral thigh must be administered immediately—antihistamines and corticosteroids are NOT substitutes for epinephrine in anaphylaxis 7, 1

Common Pitfalls to Avoid

• Do not delay stinger removal to find the "proper" scraping tool—immediate removal by any method is what matters 2, 3
• Do not prescribe antibiotics routinely for swelling—this is IgE-mediated allergic inflammation, not infection 1, 4
• Do not rely on antihistamines or corticosteroids if systemic symptoms develop—only epinephrine treats anaphylaxis effectively 7, 1
• Do not dismiss large local reactions as trivial—patients with recurrent large local reactions and unavoidable exposure should be referred to an allergist for consideration of venom immunotherapy 1

When to Refer to an Allergist

• Any patient who develops systemic symptoms (even just widespread hives) should be referred for venom-specific IgE testing and consideration of venom immunotherapy, which reduces future systemic reaction risk from 25-70% to less than 5% 1
• Patients with large local reactions causing significant functional impairment or vascular compromise 1