The Full Story
Bees, wasps, hornets, yellow jackets: most people can't tell them apart. But they all sting - and there's no mistaking that sting! The pain is immediate and intense. The area becomes red, itchy, and swollen.
Lots of people call Poison Control after being stung. They worry that they're having an allergic reaction because the pain, itching, and swelling are so alarming. How can you tell the difference between a miserable sting and an actual allergic reaction?
Anaphylaxis is the name for severe allergic reactions that can cause a person to collapse and die. An anaphylactic reaction to a sting (or just about anything else) causes trouble breathing. This happens quickly, within minutes to an hour. The victim could have chest tightness and a feeling of tightness in the throat. The person could feel faint. Hives (red, itchy bumps on the skin) pop up away from the bite. This is a true medical emergency. Call 911 right away! If the person has a kit to treat allergic reactions, start using it immediately. (Follow directions to use the "Epi-Pen", a shot of epinephrine. Usually, you would open the package and push the auto-injector against the person's thigh.) Put the person on the floor, on his or her left side. Put any pets behind closed doors. Unlock the door so emergency personnel can get in. If you see a stinger in the wound, remove it as described below.
A person who has multiple stings might also need emergency care. In this case, it's not an allergic reaction. But, the quantity of venom injected all at once could cause nausea, dizziness, faintness, and even seizures.
All symptoms of an "ordinary" sting are at the sting site itself. Expected effects are pain, swelling, redness, and itching. All effects are at that specific spot. Even if the area is still red, swollen, itchy, and painful the next day – it's an expected reaction, not an allergic reaction. Treatment is in two parts:
- If there is a stinger in the skin, remove it gently. Scrape it out with something that's not sharp: a finger nail, the edge of a credit card, or the dull side of a knife. Do not use tweezers or fingers to grab the stinger and pull it out; that pushes more venom into the skin.
- Wash the area well with soap and water. Apply ice to help relieve itching, swelling, and pain. There's no one treatment that works all the time. You can apply a cortisone cream, an antihistamine cream, or a paste of baking soda and water. Treat severe itching with an antihistamine. Diphenhydramine (Benadryl®) and chlorpheniramine might help. Be sure to follow label instructions for dose and precautions; these drugs can cause sleepiness. Try an over-the-counter pain reliever for pain.
In all cases, try to avoid scratching. (That's easy to say…) Scratching the bite site could cause an infection. Covering the sting site might help.
Has the victim had a tetanus booster in the last five years? If not, or you don't know, call the doctor to see if a booster would be a good idea.
If your local reaction is very large - several inches across - give your doctor a call. Some people with this type of reaction go on to develop severe allergies or anaphylaxis.
You can call Poison Control at 1-800-222-1222 at any time. The poison specialists will answer your questions about what to do and whether you're having an allergic reaction. If you've been stung, Poison Control will stay in touch with you until your symptoms are no longer troublesome. If you need emergency care, Poison Control can contact an ambulance for you and alert the hospital that you're coming.
Rose Ann Gould Soloway, RN, BSN, MSEd, DABAT emerita
Bilò MB. Anaphylaxis caused by Hymenoptera stings: from epidemiology to treatment. Allergy. 2011; 66 (Suppl. 95): 35–37.
Rangan C. Emergency department evaluation and treatment for children with arthropod envenomations: immunologic and toxicologic considerations. Clin Ped Emerg Med. 2007;8:104-109.