Bee & Insect Stings

During spring and summer bees and other flying insects are busy collecting food. Unfortunately sometimes we humans get in their way. In order to protect themselves, they end up attacking and stinging us. Most insect stings produce only local discomfort. Occasionally it can lead to more severe reactions called anaphylaxis.

Anaphylaxis from insect stings results in a significant number of fatalities each year. It is estimated that potentially life-threatening systemic reactions to insect stings occur in 0.4% to 0.8% of children and 3% of adults. At least 40 deaths occur in the U.S. yearly from reactions to insect stings. It is likely that additional deaths are due to insect sting but not recognized and therefore not reported.


Several insects can sting and, due to the anxiety that takes place when a sting occurs, it is very difficult to identify the one to blame. Other insects that can sting are: Yellow jackets, Hornets, Wasps, Honeybees. These insects are very different but all make venom that causes inflammation when inserted through the sting.

Yellow Jackets
Ground-dwelling insects, nests are concealed in the ground or behind siding or retaining walls. They have smooth thorax, and abdomen is yellow and black. They may be very aggressive and sting with minimum provocation, especially in the presence of food.

They make aerial nests that resemble Japanese lanterns, generally in trees, shrubs, roof overhangs, or under surfaces of wooden decks. Nests may not be easily visualized. They can be very aggressive, particularly close to the nest.

Have long, thread-like waists, oval abdomens, and elongated posterior legs. Coloration and size of paper wasps vary from region to region. The nests are honeycombed, open, and cone-shaped, often built in dark areas, such as under eaves or porches of homes, behind shutters, or inside dryer vents.

Hives may be domestic or wild. The wild hives may be found in tree hollows or old logs and may contain hundreds of bees. They are usually not aggressive when away from their hives. Always leave a barbed stinger with attached venom sac when they sting.

Black and yellow, both the thorax and abdomen are hairy. Rarely cause sting reactions. Easy to avoid because are slow and noisy. Venom is not commercially available for diagnosis or therapy.


Most people experience only local reactions. Localized reactions are of little medical consequence and no specific treatment is required. Reactions consist of redness, swelling, itching and pain at the sting area. Sometimes they can become large with extensive red swelling surrounding the sting site, increase in size for 24 to 48 hours, swelling to more than 10 cm in diameter.

There may be involvement of more than one joint area and may persist for several days, 5 to 10 days to resolve. It may be associated with itching, pain, or both. Treatment is aimed at reducing local pain, itching and swelling and consists of cold compresses, oral antihistamines, and/or oral analgesics.

The risk of a systemic reaction in patients who experience
large local reactions is no more than 5% to 10%. Systemic ReactionsSystemic Reactions range from skin responses (like, hives and swelling) to life-threatening reactions manifested by wheezing, difficulty breathing, difficulty swallowing, anxiety and decrease in blood pressure. Treatment of anaphylactic reactions caused by insect stings is the same as for other causes of anaphylaxis. If a stinger is present, it should be removed as quickly as possible.


Seek treatment if you experience any of the following:
  • Experience a systemic reaction to an insect sting
  • Experience anaphylaxis with an insect sting as a possible cause
  • Need education regarding stinging insect avoidance or emergency treatment
  • Need venom immunotherapy
  • Have a coexisting condition that may complicate treatment of anaphylaxis (taking B-blockers, hypertension, or a history of cardiac arrhythmias)

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