Bee Sting
 Bee Sting of Upper Arm
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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).
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
HOME CARE ADVICE
- 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.
- 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.
- Pain Medicines:
- For pain relief, take acetaminophen, ibuprofen, or naproxen.
- Take 650 mg by mouth every 4-6 hours. Each Regular Strength Tylenol pill has 325 mg of acetaminophen.
- Another choice is to take 1,000 mg every 8 hours. Each Extra Strength Tylenol pill has 500 mg of acetaminophen.
- The most you should take each day is 3,000 mg.
- Take 400 mg by mouth every 6 hours.
- Another choice is to take 600 mg by mouth every 8 hours.
- Use the lowest amount that makes your pain feel better.
- Take 250-500 mg by mouth every 12 hours.
- Use the lowest amount that makes your pain feel better.
- Acetaminophen is thought to be safer than ibuprofen or naproxen in people over 65 years old. Acetaminophen is in many OTC and prescription medicines. It might be in more than one medicine that you are taking. You need to be careful and not take an overdose. An acetaminophen overdose can hurt the liver.
- Caution: Do not take acetaminophen if you have liver disease.
- Caution: Do not take ibuprofen or naproxen if you have stomach problems, kidney disease, are pregnant, or have been told by your doctor to avoid this type of medicine. Do not take ibuprofen or naproxen for more than 7 days without consulting your doctor.
- Before taking any medicine, read all the instructions on the package
- 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.
- 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.
- 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.
- 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
- 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).
- 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.
Author: David A. Thompson, M.D.
Last reviewed: 11/18/2011
Last revised: 12/13/2011 5:24:37 PM
