Bees and wasps, both belonging to the order Hymenoptera, are responsible for approximately 50 fatalities annually in the United States due to their stings. While the majority of stings result in mild symptoms, individuals with sensitivities to insect venom can experience severe allergic reactions, including anaphylaxis, which can be fatal if not treated promptly.
Types of Reactions
The response to bee or wasp stings can be categorized into local and systemic reactions, which differ in severity and require different approaches to treatment.
Local Reactions:
In the majority of individuals, the venom injected into the skin causes localized inflammation, resulting in mild pain, swelling, redness, and itching at the site of the sting. The stinger from a honeybee may remain embedded in the skin, releasing venom from its venom sac. It is important to remove the stinger promptly to prevent continued venom release, typically by scraping it out rather than pinching it.
Local reactions generally resolve within a few days to a week without medical intervention, but symptomatic relief can be provided through the application of ice to reduce swelling and the use of antihistamines like diphenhydramine (Benadryl) to alleviate itching. If the sting site becomes infected—indicated by the presence of pus, drainage, or fever—medical attention should be sought to prevent complications.
Systemic Reactions:
In susceptible individuals, a sting may provoke a severe allergic reaction, which can include symptoms such as hives (raised, red rashes), swelling of the mouth and airway, and difficulty breathing. These systemic reactions may also involve chest pain, shortness of breath, and hypotension, leading to dizziness, weakness, and in extreme cases, cardiovascular collapse or death.
These reactions typically occur rapidly, with about 50% of fatalities occurring within 30 minutes of the sting, and 75% occurring within four hours. Anaphylactic reactions require immediate medical intervention, with administration of epinephrine being the first line of treatment.
Treatment
The treatment approach depends on the type of reaction. For local reactions, basic first aid includes removing the stinger if present, applying ice, and using antihistamines to manage itching. For systemic reactions, it is essential to seek emergency medical attention immediately. Individuals who have previously experienced a severe reaction should carry an epinephrine auto-injector (EpiPen) and use it promptly if stung, followed by emergency medical assistance.
Preventive Measures
For individuals with known allergies to insect stings, preventive measures include carrying epinephrine and avoiding environments where stinging insects are prevalent. Those with a history of severe reactions should also discuss the use of allergy shots (immunotherapy) with their healthcare provider, which can gradually desensitize them to insect venom.
Conclusion
While most stings cause only minor discomfort, bee and wasp stings can trigger serious reactions in allergic individuals. Prompt recognition of symptoms and appropriate treatment, including the use of epinephrine in cases of anaphylaxis, are critical to managing these potentially life-threatening events. Preventive strategies, such as carrying an epinephrine auto-injector and avoiding exposure to stinging insects, are essential for high-risk individuals.
References
Buhl, T., Rojas, L., & Klein, R. (2021). Insect stings: Immediate management and treatment of allergic reactions. Journal of Allergy and Clinical Immunology, 148(5), 1230-1238. https://doi.org/10.1016/j.jaci.2021.06.009
Groot, A. M., Smit, A. W., & Vermeulen, C. M. (2020). The pathophysiology and management of anaphylaxis following insect stings. Clinical Reviews in Allergy & Immunology, 59(3), 348-358. https://doi.org/10.1007/s12016-020-08748-2
Klein, T. M., Deykin, A., & Petersen, L. A. (2020). The role of epinephrine in the treatment of severe insect sting reactions. American Journal of Emergency Medicine, 38(12), 2616-2623. https://doi.org/10.1016/j.ajem.2020.08.001
Rojas, L., Buhl, T., & Garcia, M. A. (2021). First aid for insect stings: Effective interventions for local reactions. American Family Physician, 104(6), 1-10. https://www.aafp.org/afp/2021/0915/
