How to treat bee and wasp stings

Insect reactions can be caused by blood-sucking insects or those with

venomous stingers, which is the focus of the information here - bees in
particular.
The most common reaction to an insect is a local reaction to the bite of a
mosquito, but while this can spread disease, the reaction itself rarely produces
serious disease.
1

Bee stings, however - and similarly wasp stings - can sometimes lead to
serious illness.
Such stings can be grouped by the insects known as H
ymenoptera- and the
most common sting is from honeybees, but some wasps and other insects can
also sting, particularly the Vespidae family of wasps. Yellow jacket wasps are
the major cause of allergic reactions to insect stings in the US.
While the information here refers to bee stings for convenience, it applies to
stings cause by both bees and wasps. Look out for introductions to recent
developments that have been covered by MNT's news stories. Also look out
for links to information about related conditions.
1

What is a bee sting?

A bee sting is a puncture wound or laceration in the skin caused by a bee.

The venom contained in a bee or wasp sting induces a local toxic reaction in
all people at the site of attack.
3

1-3

In some people, this reaction is an allergic one - but only in those people who
have been sensitized previously by a sting.
1-3

The stinging apparatus consists of a sac of venom attached to a barbed

stinger. When a bee or wasp stings, the sac contracts, dumping venom into
the tissue.
3

In the US, it is estimated that death from bee stings is 3 or 4 times more
common than from snakebites. The Africanized honeybee, or killer bee, has
reached the southern states and some south-western ones. These are more
aggressive and attack in swarms, causing a more severe reaction than other
bees.
2

The US Centers for Disease Control and Prevention (CDC) has produced
a pictorial guide to stinging Hymenoptera, including ants and wasps as
well as bees.

What are the symptoms of a bee sting?

Some symptoms that develop after a bee sting signal a severe allergic reaction and
need urgent medical attention - go to anaphylaxis symptoms that need
emergency care.

Most reactions to a sting are mild to moderate and do not involve a severe allergy in children, for example, only about 3% experience any allergic reaction.4
An uncomplicated bee or wasp sting produces these symptoms:2,5,6

Pain at the site of the sting - instant, sharp, burning pain usually lasting a few
seconds (find out the most painful place for a bee sting, or the insect with
the most painful sting)

A swollen red mark (erythema) at the site of about half an inch but up to two,
which can be itchy and painful

The swelling and redness (hives, welts) may peak at around 48 hours after
the sting and last for up to a week.

Some stings produce the following symptoms:3,5,6

Extreme redness and swelling that enlarges up to 12 inches across

Sometimes an entire extremity or limb can swell up but should start to go

down after a few days

Worse symptoms are more likely if there have been multiple stings - there can
be a rash, fever, nausea andheadache. Multiple stings can be fatal for
children
Swollen and painful joints can occur after several days in rare cases

Some symptoms are the same as those suffered by people with a severe
allergic reaction, so get urgent help just in case - these include nausea,
vomiting or diarrhea, feeling dizzy or fainting, difficulty breathing and
lowblood pressure.
Sometimes a sting can become infected. Consult a doctor if the area affected shows

a puss discharge or there is an increase in the normal pain, swelling and redness
that was produced by the initial sting.6

Home treatment for a bee sting, and prevention

Most bee stings can be treated without medical attention. First aid for someone who
has been stung by a bee or wasp includes a number of dos and don'ts.2-4,6-9

DO:

Stay with the person to watch out for any severe reaction that could develop

Call for urgent medical help if there are signs of a severe allergic reaction
Remove the stinger promptly if it remains - honey bee stingers are barbed and
usually remain in the skin, and prompt removal is needed since the injection
mechanism continues

To remove the stinger, wipe over it with a piece of gauze, or scrape a finger
nail, piece of card or a bank card over it

Remain calm - walk away calmly since wasps and hornets can sting again
(they do not usually leave a stinger)

Wash the site of the sting with plain soap and water

Apply a cold compress - ice, frozen peas or cold cloth to reduce swelling

Offer aspirin or acetaminophen if desired to reduce pain; sprays or creams

containing anesthetic and antihistamine are available from pharmacists, as
are oral antihistamines for reducing swelling.

DON'T:
Leave the person alone - they may develop a severe reaction

Use tweezers to remove the stinger

Squeeze the stinger in an attempt to remove it - this can cause more venom
to be injected

Scratch the sting - this could aggravate the problem and lead to an infection

Panic! Waving around will not help, and wasps and hornets do not usually
leave a stinger - so they may sting again

Use calamine lotion, vinegar or bicarbonate of soda - these are not

recommended treatments, and the aim of neutralizing the acidic venom with
the latter two is pointless since the venom gets deep into the tissues

Burst any blisters that develop since this can lead to infection.

Prevention

A number of practical steps can be taken to reduce the risk of being stung by a
bee.2,3,5,6,9

DO:

Wear light-colored, smooth clothing that is not too loose

Keep clothing clean and maintain personal hygiene - sweat may anger bees

Wear shoes

Remove nests near the home - but ensure a professional is engaged

Keep areas clean, especially involving food - cover food containers and trash
cans

Keep an eye out for bees - use widely brimmed cups when drinking sweet
drinks to make seeing a bee easier

Take care with any activities such as garden trimming that could provoke a
nest.

DON'T:

Wear brightly colored and flower print clothing, or fragrances and cosmetics
that have floral scents; bananasand banana-scented toiletries should also be
avoided

Wear loose clothing that can trap bees and insects

Wear open-toed shoes

Panic! Avoid waving arms and provoking bees and wasps

Attempt to remove nests yourself - get a professional because many insects

sting when provoked (bees are aggressive usually only when hives are
attacked).

When does a bee sting need medical care?

If an insect sting has led to swelling or blistering, or if signs of infection develop, such
as pus, see your health care provider.6
A doctor may help with local swelling, itching or pain with treatments that include
painkillers, topical corticosteroids and antihistamines.3
If the local reaction is larger and more severe, such as when the local swelling
(edema) is severe, oral corticosteroids may be prescribed for a course of 3 to 5 days
(for example, prednisolone). This may be in addition to painkillers and
antihistamines.3

Anaphylaxis - symptoms that need emergency care

The following symptoms may signal a severe allergic reaction that can be
life-threatening (anaphylaxis), so if any appear following a bee or any other insect
sting, emergency medical care is needed - CALL AN AMBULANCE:6

Wheezing or difficulty breathing

Nausea, vomiting or diarrhea

Fast heart rate

Dizziness or feeling faint

Difficulty swallowing (dysphagia)

Confusion, anxiety or agitation.

Where is the most painful place for a bee sting?

Perhaps it would not be the most pressing issue when you have been stung by a bee
to know where it hurts most, although there may be consolation in knowing it could
have been worse.

Nonetheless, one researcher felt that it was important to learn how different sting
locations around the body compared on a rating scale for pain.10

Michael Smith, PhD, of Cornell University in Ithaca, New York, selected 25 locations
throughout the human body and conducted an experiment to rate the painfulness of
a sting at each location caused by a honey bee.

Compared with the rating of 5 assigned to the median level of pain at the forearm, all
stings were rated on a scale from 1 to 10, from low to high pain severity.

Randomly assigning which location he would allow himself to be stung next and
using the same morning slot, Dr. Smith left at least 5 minutes between each sting for
the pain to subside. He subjected himself to three rounds of stinging for each
location, to give some consistency to the results.

The eye-watering results for the ranking of painful

honey bee sting locations were, in order of worst pain
first (rating out of 10):
1. Nostril (9.0)
2. Upper lip (8.7)

3. Penis shaft (7.3)

4. Scrotum (7.0)
5. Palm (7.0)
6. Cheek (7.0)
7. Armpit (7.0)
8. Nipple (6.7)
9. Abdomen (6.7)
10. Middle finger tip (6.7).
The remaining ranked as follows: top of the foot (6.0), behind the ear (5.3), top of the
hand (5.3), back of the knee (5.0), back of the neck (5.3), foot arch (5.0), forearm
(5.0), upper thigh (4.7), wrist (4.7), lower back (4.0), buttock (3.7), calf (3.7), middle
toe tip (2.3), skull (2.3), upper arm (2.3).

What is the most painful insect to be stung by?

A bee sting is clearly painful - but other insects in the same group produce a worse
pain, and one scientist has produced a rating known as the "Schmidt sting pain
index."

Produced by Justin Schmidt, PhD, an entomologist from the Southwestern Biological

Institute in Arizona, US, it looks at the insect group hymenoptera, which includes
bees, wasps and ants.

Dr. Schmidt's list of stings groups them into a rating from low to high pain from 1 to 4
- the honey bee sting produces a mid-level pain:11

Level 1 - fire ant, sweat bee

Level 1.5 - bullhorn acacia ant

Level 2 - honey bee, yellow jacket wasp, bald-faced hornet

Level 3 - paper wasp, harvester ant

Level 4 - bullet ant, tarantula hawk wasp.