Bee Sting

Symptoms

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

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General Information

• Hymenoptera is the scientific name for the class/order of venomous insects which include: bees, wasps, hornets, yellow jackets.
• Over 95 percent of stings are from honeybees or yellow jackets. 
• Tetanus booster following a sting is not considered necessary.

Sting Symptoms

• The stinger injects venom into the skin; it is the venom that causes the pain and other symptoms. The main symptoms are localized pain, swelling, itching, and mild redness at the sting site.
• Pain: Severe pain or burning at the site lasts 1 to 2 hours. Itching often follows the pain.
• Swelling: Normal swelling can increase for 24 hours following the sting. Stings of the upper face can cause marked swelling around the eye, but this is harmless.
• Redness: Bee stings can normally become red. That doesn't mean they are infected. Infections rarely occur in stings.
• Expected Course: The redness can last 3 days and the swelling 7 days.

Removing the Stinger

• The stingers on wasps, hornets, and yellow jackets do not detach, and thus they are able to sting multiple times.
• Honey bees are capable of stinging only once because they have tiny barbs on their stingers that gets embedded in the skin. After stinging, the stinger apparatus detaches from the bee's body and the bee dies. Therefore, it is only with honey bee stings that there is a stinger that sometimes needs to be removed. 
• There are several different methods of removal. Removing the stinger quickly is more important than the type of removal used (Visscher reference). The patient can grab it with his fingers, scrape it out with a credit card, or use scotch tape.

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).

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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

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FIRST AID Advice for Minor Bee Sting (localized symptoms only):

• Apply a cold pack to the area of the sting for 10-20 minutes.

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.

Should I Call?

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
• Previous life-threatening reaction (anaphylaxis) to sting and it has been less than 2 hours since sting
• NOTE: Symptoms above may indicate anaphylaxis. 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
• Abdominal pain or vomiting 
• Redness or red streak and you also have a fever

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

• You think you need to be seen
• Redness was getting much better and now it is getting larger (worse). (Note: Any redness in the first 24 hours is due to sting 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

Care at Home

HOME CARE ADVICE

Care Advice for Bee - Wasp - 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 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.
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:
   • 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.
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

Preventing Stings

1. 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).

Tetanus Vaccination

1. Getting a Tetanus Booster:
   • Tetanus vaccination (booster) after a bee sting is not necessary.
   • However, if it has been more than 10 years since your last tetanus vaccination, it is appropriate from a preventive health care standpoint to obtain a vaccination (i.e., Td or TDaP) sometime in the next couple weeks.  

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

Photo Example

 

Bee Sting of Upper Arm

This photo shows the typical localized reaction to a bee sting. There is mild redness in an oval 4 inches (10 cm) wide of the left upper arm.

Bee Sting of Left Hand

Moderate swelling of left hand from a bee sting that occurred the day before.

First Aid - Removing a Stinger

The stinger looks like as a tiny black dot in the center of the sting. There are several different methods of removal. Removing the stinger quickly is more important than the type of removal used.

• You can scrape it out with a credit card or finger nail.
• You can also use adhesive tape.
• If only a small fragment remains, don't worry about it. It will shed with the skin.

Note: In many cases no stinger will be present. Only bees leave their stingers. Wasps, yellow jackets, and hornets do not.

Source: LMS Inc., Copyright 2000-2009. Self Care Decisions, LLC. Used by Permission. 

Wasp

Honeybee Collecting Pollen

Hornet

Bald-faced "hornet" (Dolichovespula maculata).

Source: Wikimedia Commons

Permission is granted to copy, distribute and/or modify this document under the terms of the GNU Free Documentation License.

This is a public domain image file from Wikimedia Commons. Wikimedia is a freely licensed media repository.

First Aid - Shock

• Lie down with the feet elevated (Reason: counteract shock).

Note: In this illustration the individual in shock is laying down and his feet have been placed up on a stack of blankets.