Bee Sting Treatment

1. Immediate First Aid (All Stings)

• Clean the site: Wash with soap and water; disinfect the area.
• Ice pack: Apply immediately to reduce pain and slow venom spread. Use a cloth between ice and skin. Apply for 15-20 minutes, repeating each hour as needed.
• Elevate: If stung on an arm or leg, elevate the limb to reduce swelling.
• Remove jewelry/tight items near the sting before swelling begins.

2. Treating Mild to Moderate Local Reactions

• Ice packs
• Oral antihistamines
• NSAIDs
• A short steroid taper (e.g., oral prednisone) in significant cases

3. Warning Signs - When to Seek Emergency Care

• Difficulty breathing or wheezing
• Swelling of the throat, tongue, or lips
• Dizziness, fainting, or rapid heartbeat
• Hives/urticaria spreading beyond the sting site
• Nausea, vomiting, or loss of consciousness
• Sting in the mouth or throat (risk of airway swelling)
• Multiple stings (>10 in adults, >5 in children) - even without allergy, mass envenomation can cause systemic toxicity

4. Anaphylaxis Management

1. Epinephrine (adrenaline) FIRST - this is the only truly life-saving drug. Use an auto-injector (EpiPen) if available: inject 0.3 mg (0.3 mL of 1:1000) intramuscularly into the outer thigh. Can repeat every 20-30 minutes if needed.
2. Call 911 / emergency services immediately, even if epinephrine improves symptoms.
3. Lay the patient flat (or in recovery position if unconscious). Do NOT let them sit or stand upright - this worsens hemodynamic collapse.
4. H1 + H2 antihistamines (e.g., diphenhydramine + ranitidine) as adjuncts - they do NOT replace epinephrine.
5. Bronchodilators (e.g., salbutamol/albuterol inhaler) for bronchospasm.
6. IV epinephrine is reserved for refractory anaphylaxis in hospital settings.
7. Observe for 24 hours for biphasic reactions (anaphylaxis can recur 4-12 hours after apparent resolution).

Note: Glucocorticoids (steroids) are no longer routinely recommended for acute anaphylaxis - they are too slow-acting to address immediate symptoms and do not reliably prevent biphasic reactions. (Rosen's Emergency Medicine)

5. Long-Term Prevention for High-Risk Patients

• People with a known allergy should always carry an epinephrine auto-injector and wear a medical alert bracelet.
• Venom immunotherapy (desensitization) is highly effective - repeated injections of purified bee/wasp venom build a blocking IgG antibody response and dramatically reduce the risk of future anaphylaxis. Honeybee, wasp, and yellow jacket venoms are commercially available for this purpose.
• Skin testing and venom-specific RAST (radioallergosorbent test) help identify suitable candidates for immunotherapy.

Quick Reference Summary