Insect Bite

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DEFINITION

• Itching, pain, or swelling from an insect bite
• Itchy Insect Bites: Bites of mosquitoes, chiggers (harvest mites), fleas, and bedbugs usually cause itchy, red bumps.
• Painful Insect Bites: Bites of horseflies, black flies, deer flies, gnats, harvester ants, blister beetles, and centipedes usually cause a painful, red bump. Within a few hours, fire ant bites can change to blisters or pimples.

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) and keep it nearby if there is any risk of a sting.
• Anaphylaxis can occur following fire ant stings, but rarely with other insects. It mainly occurs with bee, yellow jacket or wasp stings.

Prevention

• Wear long pants and long-sleeved shirts.
• Avoid being outside when the insect is most active. Many insects that cause itchy bites are most active at sunrise or sunset (e.g., Chiggers, No-See-Ums, Mosquitoes).
• Insect repellents containing DEET also seem to be effective in preventing many itchy insect bites. Read the label carefully.

See More Appropriate Topic (instead of this one) If

• BEE OR YELLOW JACKET STING
• SPIDER BITE
• TICK BITE

FIRST AID ADVICE

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 (diphenhydramine; adult dose 50 mg) or any other available antihistamine.

FIRST AID ADVICE for Anaphylactic Shock (pending EMS arrival):

• Lie down with feet elevated.

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WHEN TO CALL YOUR DOCTOR

Call 911 Now (you may need an ambulance) If

• Passed out (fainted)
• Difficult to awaken or acting confused
• Wheezing or difficulty breathing
• Hoarseness, cough or tightness in the throat or chest
• Swollen tongue or difficulty swallowing
• Previous severe allergic reaction same insect bite. (not just hives or swelling)
• NOTE: Symptoms above may indicate anaphylaxis. Anaphylaxis usually starts within 20 minutes, and always by 2 hours following a bite.
• Sting. See First Aid.

Call Your Doctor Now (night or day) If

• You feel weak or very sick

• Hives or swelling elsewhere on the body
• Fever and bite looks infected (i.e. spreading redness, pus)
• Severe pain persists for more than 2 hours after pain medicine

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

• You think you need to be seen
• New redness or red streak occurs around the bite after the first 24 hours
• Scab that looks infected (drains pus or increases in size) not improved after applying antibiotic ointment for 2 days

Call Your Doctor During Weekday Office Hours If

• You have other questions or concerns

Self Care at Home If

• Normal insect bite and you don't think you need to be seen

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HOME CARE ADVICE FOR INSECT BITES

1. Local Treatment - Itchy Insect Bites (including all mosquito bites)
   • Apply calamine lotion or a baking soda paste.
   • If the itch is severe, use 1% hydrocortisone cream. Apply 4 times a day until the itch is less severe, then switch to calamine lotion.
   • Try applying firm, sharp, direct, steady pressure to the bite for 10 seconds. A fingernail, pen cap, or other object can be used.
2. Oral Antihistamine Medication for Severe Itching: Take an antihistamine by mouth to reduce the itching. Diphenhydramine (Benadryl) is a good choice. The adult dosage of Benadryl is 25-50 mg by mouth, you can take it up to 4 times a day.
   • Do not take antihistamine medications if you have prostate enlargement.
   • Antihistamines may cause sleepiness. Do not drink, drive or operate dangerous machinery while taking antihistamines.
   • An over-the-counter antihistamine that causes less sleepiness is loratadine (e.g., Alavert or Claritin).
   • Read the package instructions thoroughly on all medications that you take.
3. Local Treatment - Painful Insect Bites
   • Rub the bite for 15 to 20 minutes with a cotton ball soaked in a meat tenderizer solution. This will usually relieve the pain. (Caution: don't use near the eye)
   • If not available, use a baking soda solution on a cotton ball.
   • If neither is available, apply an ice cube for 20 minutes.
4. Pain Medication:
   • For pain relief, take acetaminophen or ibuprofen
   • Acetaminophen (e.g., Tylenol): The dose is 650 mg by mouth every 4 hours or 1000 mg by mouth every 6 hours. Maximum dose per day = 4000 mg.
   • Ibuprofen (e.g., Motrin, Advil): The dose is 400 mg by mouth every 6 hours or 600 mg by mouth every 8 hours.
   • People who are over 65 Years of age: Acetaminophen is generally considered safer than ibuprofen. Acetaminophen dosing interval should be increased to every 8 hours because of reduced liver metabolism. Maximum dose per day = 3000 mg.
   • CAUTION: 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.
   • CAUTION: Do not take acetaminophen if you have liver disease.
   • Read the package instructions thoroughly on all medications that you take. 
5. Antibiotic Ointment: If the insect bite has a scab on it and the scab looks infected, apply an antibiotic ointment 4 times per day.
   • Cover the scab with a Band-Aid to prevent scratching and spread.
   • Repeat washing the sore, the antibiotic ointment and the Band-Aid 4 times per day until healed.
6. Expected Course: Most insect bites itch or hurt for 1 to 2 days. The swelling may last a week.
7. Call Your Doctor If:
   • Severe pain persists more than 2 hours after pain medicine
   • Infected scab doesn't look better after 48 hours of antibiotic ointment.
   • Bite looks infected (redness, red streaks, increased tenderness)
   • You become worse

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