Fast management of bee bites
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Fast Management of Bee Stings
1. Stinger Removal
Remove the stinger immediately — the honeybee leaves a barbed stinger embedded in the skin that continues to pump venom. Scrape it off (e.g., with a card edge or fingernail) or use forceps. Speed matters more than technique. Wasps and hornets do not leave their stingers.
2. Local Reactions (Most Cases)
| Step | Action |
|---|---|
| Stinger out | Remove promptly |
| Cold | Apply ice pack immediately to reduce pain and swelling |
| Topical | Topical anesthetics for pain relief |
| Oral antihistamines | For pruritus and mild urticaria |
| NSAIDs/paracetamol | For pain |
| Persistent/large local swelling | Intralesional triamcinolone (5 mg/mL diluted in 2% lidocaine) injected at the site |
| Severe local reaction | Oral prednisone |
Most local reactions resolve within hours to a few days.
3. Systemic / Anaphylactic Reaction (Emergency)
Anaphylaxis can occur within minutes of the sting. Act immediately:
| Priority | Treatment |
|---|---|
| First line | Epinephrine (adrenaline) 0.3 mL of 1:1000 IM (anterolateral thigh) |
| Repeat if needed | Repeat epinephrine after 10 minutes if no improvement |
| Adjuncts | IV/IM antihistamines (H1 + H2 blockers) |
| Corticosteroids | IV/IM corticosteroids to prevent biphasic reaction |
| Bronchospasm | Inhaled bronchodilators (salbutamol) |
| Prolonged reaction | Corticosteroids + epinephrine may be needed for several days |
| Carry | All susceptible persons should carry a self-injectable epinephrine device (EpiPen) |
4. Delayed Reactions
- Serum sickness (fever, urticaria, joint pain) may appear 7–10 days after the sting — treat with corticosteroids and antihistamines.
- Granulomatous skin reactions at the sting site have been reported.
5. Long-Term Prevention (High-Risk Patients)
- Refer to an allergist for evaluation.
- Venom immunotherapy (VIT) — desensitization with purified bee/vespid venom significantly reduces risk of future anaphylaxis. Rush and ultra-rush protocols are available.
- Sublingual immunotherapy looks promising as an alternative route.
Key Points
- Epinephrine IM is the cornerstone of anaphylaxis — antihistamines and steroids are adjuncts only.
- 10% of all anaphylaxis cases in the US are attributed to Hymenoptera stings.
- At least 90–100 deaths per year in the US are due to insect sting anaphylaxis.
— Andrews' Diseases of the Skin, p. 514–515 | Rosen's Emergency Medicine, p. 817 | Tietz Textbook of Laboratory Medicine, 7th ed.
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