Bee Stings a Possible Minor Emergency

Seena Zierler-Brown, Pharm.D.

Bee stings of the Hymenoptera order are very common in the United States. One to two per 1000 patients are allergic or hypersensitive. Mortality ascends three- to four-fold with bee stings vs. snakebites due to potential anaphylactic reaction from venom. The venom combines with antibodies associated with mast cells on vital organs releasing histamine and other vasoactive substances. Blood pressure drops in response to excess fluid release into body tissues and resultant fluid accumulation in the lungs. Alarm symptoms include: wheezing, tightness in throat or chest and dizziness. Patients should seek an allergist for assessment if they suspect or have a family history of a bee allergy. A medical ID bracelet or necklace should be worn to identify the allergy. The Africanized killer honeybee, which is similar to the European honeybee, travels from South America to many southern states. This particular type of bee attacks victims in swarms, escalating the nature of the reaction. These bees, which can sting only once, are utilized in crop pollination and honey production. Yellow jackets, bumble bees, and honeybees live in colonies to defend the nest. Only females can sting since the egg-laying apparatus produces the stinger. A bee sting will cause an immediate inflammatory response approximately 1-2 inches in diameter enlarging over the course of several days with associated pain and pruritus. The inflammatory response liberates fluid from the blood to flush the venom. This process becomes expedited with a subsequent sting from the same species of insect. Additional symptoms may include: hives, nausea, itching, and vomiting occurring within minutes and lasting a few hours. The stinger may remain in the skin and should be removed quickly. Venom can enter the skin for approximately 45-60 seconds before removal. The goal is to remove the stinger within 15 seconds for reduction in severity. Scraping it out, rather than squeezing or pulling best accomplishes this. Melittin is the primary chemical responsible for pain. The site should be washed once the stinger is removed. Application of a cold compress (10 minutes on and off for 30-60 minutes) may reduce the pain followed by oral antihistamines (for swelling and itching), analgesia (with acetaminophen), calamine lotion and/or corticosteroid. Scratching around the site should be avoided to protect against microbial contact from skin surfaces, which could result in dermatological infections. Additional home remedies reported include applications of a paste of baking soda and water or meat tenderizer and water applied for twenty minutes. A preloaded syringe of epinephrine (normal syringe sting kit or auto-injector/EpiPen®) should be kept available at all times in those patients with an established history of anaphylaxis. Many patients elect to undergo desensitization to prevent future allergic reactions. Patients should be encouraged to seek medical advice if the site of the stinger is located in the neck or mouth in case of ensuing swelling constricting ability to breathe. Increased mortality due to multiple stings has been associated with elderly males (70s-80s), known to have suspected decompensated cardiopulmonary function. Children are also at an increased risk. Patients should be monitored several days (10-14) following multiple stings due to an increased risk of renal insufficiency. This life-threatening complication arises from enzymatic activity of the venom causing clogging debris of ruptured cells in the kidneys. Avoiding strong perfumes, cologne and scented soaps helps to prevent stings. Diaphoresis may provoke an attack and patients should be reminded to avoid walking barefoot since bees may be found among clover and certain vegetation areas. Remind patients to remain calm and still if a bee lands on them, it will likely leave without aggression from the patient. Return to Top