Bee Sting

DEFINITION

• Stung by a honeybee, bumblebee, hornet, wasp, or yellow jacket
• The usual symptoms are localized pain, swelling, itching, and mild redness at the sting site

General Information

• Over 95 percent of stings are from honeybees or yellow jackets.
• The sting injects venom into the human from the bee's stinger.
• Tetanus booster following a sting is not considered necessary.

Anaphylaxis

• Anaphylaxis is the medical term for a severe life-threatening allergic reaction.
• Symptoms of anaphylaxis include: feeling faint or passing out, difficulty breathing, swelling of the tongue, hives, wheezing and/or cough. Onset of symptoms is sometimes within seconds and usually within 20 minutes.
• Individuals who have had severe reactions to previous stings should have an anaphylaxis kit (e.g., Ana-Kit, Epi-Pen, Twinject) and keep it nearby if there is any risk of a sting.

Preventing Stings - Some Outdoor Activity Tips

• Wear long-sleeved shirts, long pants, and shoes when you are in grassy areas or outdoors and exposed to stinging insects.
• Avoid using perfumes and hair sprays; these attract insects.
• Wear dark or drab colored clothes rather than bright colors.
• Take special care when eating or preparing food outdoors. These odors can attract insects (especially yellow jackets).

See More Appropriate Topic (instead of this one) If

• Bite or sting from an insect other than a bee, wasp or yellow jacket, see INSECT BITES

FIRST AID Advice for Anaphylaxis - Epinephrine (pending EMS arrival):

• If the patient has an epinephrine autoinjector, the patient should use it now.
• Use the autoinjector on the upper outer thigh. You may give it through clothing if necessary.

Epinephrine is available in autoinjectors under trade names: Epi-Pen, Epi-Pen Jr, and Twinject. Epi-Pen is a single injection. Twinject has a second injection that can be used if there is no improvement after 5 minutes.

FIRST AID advice for ANAPHYLAXIS - BENADRYL (pending EMS arrival):

• Give antihistamine orally NOW if able to swallow.
• Use Benadryl (Adult dose: 50 mg) or any antihistamine cold medicine the caller might have.

WHEN TO CALL YOUR DOCTOR

HOME CARE ADVICE FOR BEE, WASP, OR YELLOW JACKET STING

1. Try to Remove the Stinger (if present):
   • The stinger looks like a tiny black dot in the sting.
   • There are several different methods of removal. Removing the stinger quickly is more important than how you remove it.
   • Use a fingernail, credit card edge or knife-edge to scrape it off. Don't pull it out. (Reason: squeezes out more venom). If the stinger is below the skin surface, leave it alone. It will be shed with normal skin healing.
   • In many cases no stinger will be present. Only bees leave their stingers. Wasps, yellow jackets, and hornets do not.
2. Local Cold for Pain - Cold Pack Method:
   • Wrap a bag of ice in a towel (or use a bag of frozen vegetables such as peas).
   • Apply this cold pack to the area of the sting for 10-20 minutes.
   • You may repeat this as needed, to relieve symptoms of pain and swelling.
3. Pain Medication: For pain relief, take acetaminophen every 4-6 hours (e.g., Tylenol; adult dosage 650 mg) OR ibuprofen every 6-8 hours (e.g., Advil, Motrin; adult dosage 400 mg).
   • Do not take ibuprofen if you have stomach problems, kidney disease, are pregnant, or have been told by your doctor to avoid this type of anti-inflammatory drug. Do not take ibuprofen for more than 7 days without consulting your doctor.
   • Do not take acetaminophen if you have liver disease.
   • Read the package instructions thoroughly on all medications that you take.
4. Hydrocortisone Cream for Itching:
   • Hydrocortisone cream applied to the sting area 4 times a day can also help reduce itching. Use it for a couple days, until the itch is mild.
   • Available over-the-counter in U.S. as 0.5% and 1% cream.
   • Available over-the-counter in Canada as 0.5% cream.
5. Antihistamine Medication for Itching: If the sting becomes very itchy, take diphenhydramine (e.g., Benadryl; adult dosage 25-50 mg) by mouth.
   • Do not take diphenhydramine if you have prostate problems.
   • Antihistamines may cause sleepiness. Do not drink, drive, or operate dangerous machinery while taking antihistamines.
   • Read the package instructions thoroughly on all medications that you take.
6. Expected Course: Severe pain or burning at the site lasts 1 to 2 hours. Normal swelling from venom can increase for 24 hours following the sting. The swelling disappears after 3 to 5 days.
7. Call Your Doctor If:
   • Difficulty breathing or swallowing (generally develops within the first 2 hours after the sting; call 911)
   • Swelling becomes huge
   • Sting begins to look infected
   • You become worse

And remember, contact your doctor if you develop any of the "Call Your Doctor" symptoms.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: David A. Thompson, M.D.

Last Reviewed: 9/21/2007

Last Revised: 9/21/2007

Content Set: Adult HouseCalls Online

Portions Copyright 2000-2007 Self Care Decisions LLC; Copyright LMS, Inc.