Bee Sting

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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 bright colors.
• Take especial 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 (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)
• Wheezing or difficulty breathing
• Hoarseness, cough or tightness in the throat or chest
• Swollen tongue or difficulty swallowing
• Abdominal pain or vomiting
• Previous life-threatening reaction (anaphylaxis)to sting and it has been less than 2 hours since sting.
• NOTE: Symptoms above may indicateanaphylaxis. Anaphylaxis usually starts within 20 minutes, and always by 2 hours following a 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
• More than 20 stings
• Sting inside the mouth

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

• You think you need to be seen
• Sting looks infected (red streaking from the sting area, yellow drainage) (Note: skin infection doesn't start until at least 24-48 hours after the sting. Any redness in the first 24 hours is due to venom.)
• Swelling is huge (e.g. larger than 6 inches; entire hand is swollen)

Call Your Doctor During Weekday Office Hours If

• You have other questions or concerns

Self Care at Home If

• Uncomplicated bee, wasp, or yellow jacket sting and you don't think you need to be seen

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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. Meat Tenderizer: Apply a meat tenderizer-water solution on a cotton ball for 20 minutes (EXCEPTION: near the eye).  This neutralizes the venom and decreases pain and swelling.  If not available, apply a baking soda solution for 20 minutes.  For persistent pain, massage with an ice cube for 10 minutes.
3. Local Coldfor Pain - Ice Massage Method: For pain, massage the area of the sting with an ice cube for 10 min as needed.
4. Local Cold for Pain - Cold Pack Method:
   • Wrap a bag of ice in a towel. (or 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.
5. 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.

6. 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.
7. Antihistamine Medication for Itching: If the sting becomes very itchy, takediphenhydramine (e.g., Benadryl; adult dosage25-50 mg)by mouth.
   • Do not takediphenhydramine 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.
8. Expected Course
   • Pain: Severe pain or burning at the site lasts 1 to 2 hours.  Pain after this period is usually minimal. Itching often follows the pain
   • Redness and Swelling: Normal redness and swelling from the venom can increase for 24 hours following the sting.Redness at the sting site is normal. It doesn't mean that it is infected. The redness can last 3 days and the swelling 7 days. 
   • Stings only rarely get infected
9. 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.

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