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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

• 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).

If not, see these topics

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

First Aid:

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.

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, red streak, or very tender area (to touch), 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

• Red or very tender (to touch) area, and started over 24 hours after the sting

• Red or very tender (to touch) area, getting larger over 48 hours after the sting

• Swelling is huge (e.g., larger than 4 inches or 10 cm; 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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