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Overview

A bee sting is a common outdoor nuisance. You can take several steps to avoid stings from bees, hornets and wasps. If you're stung, basic first aid can help ease the pain of a mild or moderate reaction. You may need emergency medical help for a severe reaction.

Symptoms

Bee sting symptoms can range from pain and swelling to a life-threatening allergic reaction. Having one type of reaction doesn't mean you'll always have the same reaction every time you're stung or that the next reaction will be more severe.

• Mild reaction. Most of the time, bee sting symptoms are minor and include instant, sharp burning pain, a welt and swelling. In most people, the swelling and pain go away within a few hours.
• Moderate reaction. Some people who get stung by a bee or other insect have a stronger reaction, with burning pain, a welt, itching, flushing and swelling that gets worse over the next day or two. The symptoms can last up to seven days.
• Severe reaction. A severe reaction to a bee sting is potentially life-threatening and requires emergency treatment. This type of reaction is called anaphylaxis. A small percentage of people who are stung by a bee or other insect develop anaphylaxis. It usually happens 15 minutes to an hour after the sting. Symptoms include rash, itching, trouble breathing, swollen tongue, trouble swallowing and tightness in the chest.
• Multiple bee stings. If you get stung more than a dozen times, you can have a bad reaction that makes you feel quite sick. Symptoms include those of a moderate reaction as well as nausea, vomiting, diarrhea, fever and lightheadedness.

When to see a doctor

Call 911 or seek immediate care for:

• A severe reaction to a bee sting that suggests anaphylaxis, even if it's just one or two symptoms. If you were prescribed emergency epinephrine that you inject yourself (EpiPen, Auvi-Q, others), use it right away as your healthcare professional directed. Inject the epinephrine first, then call 911.
• Multiple stings in children, older adults, and people who have heart or breathing problems.

Make an appointment to see a healthcare professional if:

• Bee sting symptoms don't go away within three days.
• You've had other symptoms of an allergic response to a bee sting.

Causes

A bee sting is an injury caused by bee venom. To sting, a bee jabs a barbed stinger into the skin. The stinger releases venom. The venom has proteins in it that cause pain and swelling around the sting area.

Generally, insects such as bees and wasps aren't aggressive and only sting in self-defense. In most cases, this results in one or perhaps a few stings. Some types of bees tend to swarm, stinging in a group. An example of this type of bee is Africanized bees.

Risk factors

Risk factors for a bee sting include:

• Living in an area where bees are active.
• Being near beehives.
• Spending a lot of time outdoors.

Prevention

The following tips may help reduce your risk of a bee sting:

• Take care when drinking sweet beverages outside. Use wide, open cups so you can see if a bee is in them. Inspect cans and straws before drinking from them.
• Tightly cover food containers and trash cans, as odors from them can attract insects.
• Clear away garbage, fallen fruit, and dog or other animal feces, as flies can attract wasps.
• Wear closed-toe shoes when walking outside. Don't walk through flowers.
• Don't use perfumes and scented hair and body products, as they can attract insects.
• Don't wear bright colors or floral prints, as they can attract bees.
• Be careful when mowing the lawn or trimming vegetation. Such activities might disturb insects in a beehive or wasp nest.
• Avoid being near bees, yellow jackets and hornets. For example, remove hives and nests near your home if you can do this safely.

Know what to do when bees or other stinging insects are nearby:

• If a few bees are flying around you, stay calm and slowly walk away from the area. Swatting at an insect may cause it to sting.
• If a bee or wasp stings you, or many insects start to fly around, cover your mouth and nose and quickly leave the area. When a bee stings, it releases a chemical that attracts other bees. If you can, get into a building or closed vehicle.

People who have a severe reaction to a bee sting have on average a 50% chance of anaphylaxis the next time they're stung. Talk to a healthcare professional about prevention measures such as allergy shots to avoid a similar reaction if you get stung again.

Diagnosis

To diagnose an allergy to venom from a bee sting, your healthcare professional may suggest that you have one or both of the following tests:

• Skin test. During skin testing, a small amount of bee venom is injected into the skin of the arm or upper back. If you're allergic to bee stings, you'll get a raised bump on your skin at the test site.
• Blood test. A blood test can measure how your immune system reacts to bee venom.

Your healthcare professional also may want to test you for allergies to yellow jackets, hornets and wasps. Stings from these insects can cause allergic reactions similar to those of bee stings.

Treatment

For most bee stings, home treatment is enough. Multiple stings or an allergic reaction may be a medical emergency that needs treatment right away.

Emergency treatment for allergic reactions

During an anaphylactic attack, an emergency medical team may perform cardiopulmonary resuscitation (CPR) if you stop breathing or your heart stops beating. You may be given medicines including:

• Epinephrine to reduce your body's allergic response.
• Oxygen to help you breathe.
• Antihistamines and glucocorticoids, such as prednisone, to reduce inflammation of your air passages and improve breathing.
• A beta agonist such as albuterol to ease breathing symptoms.

Epinephrine autoinjector

If you're allergic to bee stings, your healthcare professional is likely to prescribe emergency epinephrine that you inject yourself (EpiPen, Auvi-Q, others). You'll need to have it with you at all times. An autoinjector is a combined syringe and concealed needle that injects a single dose of medicine when pressed against the thigh. Always be sure to replace an autoinjector by its expiration date.

Be sure you know how to use the autoinjector. Also make sure the people closest to you know how to give you the medicine. If they're with you in an anaphylactic emergency, they could save your life. If you use an epinephrine autoinjector, go to the emergency department after.

Wear an alert bracelet that identifies your allergy to bee or other insect stings. And carry chewable antihistamines with you. Use the antihistamines if you're stung, begin to have symptoms of an allergic reaction and are able to swallow. You may use both an autoinjector and the oral antihistamine.

Allergy shots

Bee and other insect stings are a common cause of anaphylaxis. If you've had a severe reaction to a bee sting or multiple stings, your healthcare professional may refer you to an allergist for allergy testing. The allergist may suggest immunotherapy. This type of therapy is sometimes called allergy shots. These shots are generally given regularly for a few years. They can reduce or stop your allergic response to bee venom.

Lifestyle and home remedies

For a minor or moderate bee sting, follow these first-aid steps:

• Move to a safe area to avoid more stings.
• If you see a stinger sticking out of the wound — it looks like a black dot — remove it as soon as possible. Try scraping it off with a fingernail or the blunt edge of a knife. A stinger may not be present, as only bees leave a stinger. Other stinging insects, such as wasps, do not.
• Wash the sting area with soap and water.
• Remove any rings in the sting area right away, before swelling gets worse.
• Apply to the area a cloth dampened with cold water or filled with ice. Keep it on the sting for 10 to 20 minutes. Repeat as needed.
• If the sting is on an arm or leg, raise it. Swelling may increase over the next two days but usually goes away with time and elevation.
• Apply hydrocortisone cream or calamine lotion to ease itching and swelling. Do this up to four times a day until your symptoms go away.
• If needed, take a pain reliever. Pain medicine you can buy without a prescription can help ease pain. Examples are ibuprofen (Advil, Motrin IB, others) and acetaminophen (Tylenol, others). If the sting area itches, take an anti-itch medicine by mouth. This type of medicine is also called an antihistamine. Examples are diphenhydramine (Benadryl), chlorpheniramine, loratadine (Alavert, Claritin, others), cetirizine (Zyrtec Allergy) and fexofenadine (Allegra Allergy). Some of these products can make you drowsy.

What to avoid

• Don't scratch the sting area. Scratching can lead to infection.
• Don't rub the sting with mud, as mud contains many germs.
• Don't try to remove a stinger below the skin surface. It will come out over time as the skin sheds.
• Don't apply heat.

Preparing for an appointment

Bee and other insect stings are a common cause of anaphylaxis. If you've had a severe reaction to a bee sting but did not seek emergency treatment, contact a healthcare professional. You may be referred to an allergy specialist, who can find out whether you're allergic to bee or other insect venom.

List questions you want to ask your healthcare professional, such as:

• What do I do if I get stung again?
• If I have an allergic reaction, do I need to use emergency medicine such as an epinephrine autoinjector?
• How can I prevent this reaction from happening again?

Don't hesitate to ask other questions, as well.

Your healthcare professional is likely to do a physical exam and ask you a number of questions, such as:

• When and where were you stung?
• What symptoms did you have after getting stung?
• Have you had an allergic reaction to an insect sting in the past?
• Do you have other allergies, such as hay fever?
• What medicines do you take, including herbal remedies?
• Do you have other health conditions?