Bee Sting Treatment & Medication

How Bee Venom Works

Bee venom contains dopamine, histamine, neurotoxin, enzymes, and toxic peptides (wasp venom also contains serotonin). Most reactions are allergic rather than directly toxic. Serious systemic reactions from a single sting are uncommon but can be life-threatening. Most severe reactions occur within the first 30 minutes; local effects may persist 2-3 days. Delayed hypersensitivity can appear 7-10 days later.

Forensic Medicine and Toxicology (36th ed.)
Rosen's Emergency Medicine

Step 1 - Immediate First Aid

Remove the stinger - scrape it out sideways (don't squeeze/pull it, which injects more venom). Honeybees leave the barbed stinger behind; wasps do not.
Wash the area with soap and water.
Apply ice pack (wrapped in cloth) for 15 minutes to reduce swelling and pain.
Elevate the affected limb if a sting is on an arm or leg.
Remove tight jewelry/clothing near the sting site before swelling occurs.

Medications by Severity

Mild / Local Reaction (pain, redness, swelling at the site)

Medication	Purpose	Notes
Oral antihistamine (diphenhydramine/Benadryl, cetirizine/Zyrtec, loratadine/Claritin)	Reduces itch, urticaria	First-line for local symptoms
Oral analgesic (paracetamol/acetaminophen or ibuprofen/NSAIDs)	Pain relief	Standard OTC doses
Topical antihistamine or hydrocortisone cream	Local itch/inflammation	Applied directly to sting site
Topical antiseptic (tincture of iodine)	Prevent secondary infection	Applied to sting area

Antibiotics are not needed unless swelling worsens after 48 hours, suggesting secondary infection.

Moderate / Large Local Reaction (significant swelling, urticaria beyond sting site)

Medication	Purpose
Oral corticosteroids (prednisone, for a few days)	Reduce pronounced inflammation/swelling
Oral antihistamine (continued)	Ongoing urticaria control
IV calcium gluconate	Useful for urticaria control

Severe Systemic / Anaphylactic Reaction (EMERGENCY)

Anaphylaxis signs: throat tightening, difficulty breathing, wheezing, hypotension, loss of consciousness, widespread urticaria - can occur within 2-20 minutes of a sting and can be fatal in 2-15 minutes without treatment.

First-line - Epinephrine is the #1 priority. There are no absolute contraindications.

Medication	Dose / Route	Notes
Epinephrine (adrenaline)	IM 0.01 mg/kg (max 0.5 mg) of 1 mg/mL solution; repeat as needed	Inject into outer thigh (vastus lateralis); autoinjectors: EpiPen, Auvi-Q
IV crystalloid fluids	10-20 mL/kg bolus	For shock/hypotension
Oxygen	As needed	For respiratory compromise

Second-line (do NOT use instead of epinephrine):

Medication	Purpose
IV antihistamines (diphenhydramine + H2 blocker e.g. ranitidine/cimetidine)	Adjunct for urticaria/itching; H1+H2 combo is superior to H1 alone
Corticosteroids (prednisone, methylprednisolone, hydrocortisone)	Prevent biphasic/late reactions; reduce airway inflammation
Beta-agonist bronchodilator (albuterol/salbutamol nebulizer)	Wheezing/bronchospasm
Glucagon	If patient is on beta-blockers and not responding to epinephrine
Vasopressors (epinephrine or dopamine infusion)	Refractory shock

After using an epinephrine autoinjector, always go to the emergency department - biphasic anaphylaxis (return of symptoms hours later) can occur. Patients with severe reactions should be observed for several hours.

Rosen's Emergency Medicine; Tintinalli's Emergency Medicine; The Washington Manual of Medical Therapeutics

If You Know You Are Allergic

Always carry two epinephrine autoinjectors (EpiPen, Auvi-Q, Adrenaclick, or generics).
Carry oral antihistamines for early symptoms when you can still swallow.
Wear a medical alert bracelet.
Take an antihistamine at the first sign of reaction while preparing to use the injector.
Ask your doctor about venom immunotherapy (allergy shots) - regular shots over a few years can significantly reduce or eliminate the allergic response to bee stings. This is the only long-term preventive treatment.

Quick Reference Summary

Single sting, no allergy:
 Remove stinger → Ice → Antihistamine (oral) → OTC pain reliever

Large local reaction:
 + Oral corticosteroids (short course, if prescribed)

Anaphylaxis:
 EPINEPHRINE FIRST (IM) → Call 911 → Antihistamines + Steroids + O2 → IV fluids

When in doubt with any systemic symptom after a bee sting, use epinephrine immediately and call emergency services. Antihistamines alone are NOT sufficient for anaphylaxis.

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