From the Guidelines
For bee stings, immediate removal of the stinger by scraping it off with a flat edge, cleaning the area with soap and water, and applying a cold compress to reduce swelling is crucial. This approach is supported by the most recent guidelines, including the 2024 American Heart Association and American Red Cross guidelines for first aid 1.
Key Management Steps
- Remove the stinger as soon as possible by scraping it off with a flat edge to prevent further venom delivery.
- Clean the area with soap and water to reduce the risk of infection.
- Apply a cold compress to the affected area to reduce swelling and pain.
- For pain and inflammation, consider taking over-the-counter medications like ibuprofen (Advil, Motrin) 200-400mg every 6 hours or acetaminophen (Tylenol) 500-1000mg every 6 hours, as recommended by recent guidelines 1.
- Antihistamines such as diphenhydramine (Benadryl) 25-50mg every 6 hours can help alleviate itching, and topical corticosteroids like hydrocortisone cream (1%) applied 2-3 times daily for 1-2 days can reduce inflammation 1.
Anaphylaxis and Emergency Response
It is essential to recognize the signs of anaphylaxis, which can include difficulty breathing, swelling of the face or throat, dizziness, rapid heartbeat, or hives all over the body. If anaphylaxis occurs, immediate administration of epinephrine via an auto-injector and activation of the emergency response system are critical 1. People with known bee sting allergies should always carry an epinephrine auto-injector (EpiPen) and know how to use it properly.
Special Considerations
Multiple stings (more than 10-15) may require medical evaluation due to the risk of systemic toxicity. Additionally, stings to the eye should be evaluated by a trained medical professional 1.
By following these guidelines and being aware of the potential for severe allergic reactions, individuals can effectively manage bee stings and minimize the risk of morbidity and mortality.
From the Research
Management of Bee Stings
- Bee stings can cause large local reactions, defined as a skin reaction around the sting site with edema, erythema, itching, and an injury diameter >10 cm, which affects about 5% to 15% of those afflicted 2
- Standard treatments for large local reactions include ice, nonsteroidal anti-inflammatory medications, antihistamine medications, and topical or systemic corticosteroids 2
- Injection of lidocaine with epinephrine can provide rapid reversal of symptoms, including pain and edema, in large local reactions 2
- Epinephrine can also terminate the allergic cascade, preventing further symptoms from evolving 2
Anxiety and Depression in Bee Sting Allergy
- History of bee sting allergy can affect quality of life, with worry about being stung and the need to use self-injection of medicine contributing to anxiety and depression 3
- Patients with bee sting allergy who receive immunotherapy (venom immunotherapy, VIT) have lower anxiety and depression scores compared to those who do not receive VIT or only receive epinephrine 3
- VIT can improve quality of life by reducing anxiety and depression, especially in female subjects 3
Epinephrine Treatment for Stinging Insect Hypersensitivity Reactions
- Data on epinephrine treatment for stinging insect hypersensitivity (SIH) reactions is limited, but studies suggest that multiple doses of epinephrine may be necessary for some patients 4
- Among patients with systemic SIH reactions, 35% received epinephrine, and 16% of those received more than one dose 4
- Physicians should consider prescribing two doses of self-injectable epinephrine for patients at risk for systemic SIH reactions 4