Bee sting

Overview

Bee stings are a common outdoor nuisance. In most cases, bee stings are just annoying, and home treatment is all that's necessary to ease the pain. But if you're allergic to bee stings or you get stung numerous times, you may have a more-serious reaction that requires emergency treatment.

You can take several steps to avoid bee stings — as well as hornet and wasp stings — and find out how to treat them if you do get stung.

Symptoms

Bee stings can produce different reactions, ranging from temporary pain and discomfort to a severe 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 necessarily be more severe.

Mild reaction

Most of the time, bee sting symptoms are minor and include:

Instant, sharp burning pain at the sting site
A red welt at the sting area
Slight swelling around the sting area

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 bit stronger reaction, with signs and symptoms such as:

Extreme redness
Swelling at the site of the sting that gradually enlarges over the next day or two

Moderate reactions tend to resolve over five to 10 days. Having a moderate reaction doesn't mean you'll have a severe allergic reaction the next time you're stung. But some people develop similar moderate reactions each time they're stung. If this happens to you, talk to your doctor about treatment and prevention, especially if the reaction becomes more severe each time.

Severe allergic reaction

A severe allergic reaction (anaphylaxis) to bee stings is potentially life-threatening and requires emergency treatment. A small percentage of people who are stung by a bee or other insect quickly develop anaphylaxis. Signs and symptoms of anaphylaxis include:

Skin reactions, including hives and itching and flushed or pale skin
Difficulty breathing
Swelling of the throat and tongue
A weak, rapid pulse
Nausea, vomiting or diarrhea
Dizziness or fainting
Loss of consciousness

People who have a severe allergic reaction to a bee sting have a 25% to 65% chance of anaphylaxis the next time they're stung. Talk to your doctor or an allergy specialist about prevention measures such as immunotherapy ("allergy shots") to avoid a similar reaction in case you get stung again.

Multiple bee stings

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. In some cases a person will disrupt a hive or swarm of bees and get multiple stings. Some types of bees — such as Africanized honeybees — are more likely than are other bees to swarm, stinging in a group.

If you get stung more than a dozen times, the accumulation of venom may induce a toxic reaction and make you feel quite sick. Signs and symptoms include:

Nausea, vomiting or diarrhea
Headache
A feeling of spinning (vertigo)
Convulsions
Fever
Dizziness or fainting

Multiple stings can be a medical emergency in children, older adults, and people who have heart or breathing problems.

When to see a doctor

In most cases, bee stings don't require a visit to your doctor. In more-severe cases, you'll need immediate care.

Call 911 or other emergency services if you're having a serious reaction to a bee sting that suggests anaphylaxis, even if it's just one or two signs or symptoms. If you were prescribed an emergency epinephrine autoinjector (EpiPen, Auvi-Q, others), use it right away as your doctor directed.

Seek prompt medical care if you've been swarmed by bees and have multiple stings.

Make an appointment to see your doctor if:

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

Causes

To sting, a bee jabs a barbed stinger into the skin. Bee sting venom contains proteins that affect skin cells and the immune system, causing pain and swelling around the sting area. In people with a bee sting allergy, bee venom can trigger a more-serious immune system reaction.

Risk factors

You're at increased risk of bee stings if:

You live in an area where bees are especially active or with beehives nearby
Your work or hobbies require spending time outside

You're more likely to have an allergic reaction to bee stings if you've had an allergic reaction to a bee sting in the past, even if it was minor.

Adults tend to have more-severe reactions than children do and are more likely to die of anaphylaxis than children are.

Prevention

The following tips can help reduce your risk of getting stung by bees:

Take care when drinking sweet beverages outside. Wide, open cups may be your best option because you can see if a bee is in them. Inspect cans and straws before drinking from them.
Tightly cover food containers and trash cans.
Clear away garbage, fallen fruit, and dog or other animal feces (flies can attract wasps).
Wear closed-toe shoes when walking outside.
Don't wear bright colors or floral prints, which can attract bees.
Don't wear loose clothing, which can trap bees between the cloth and your skin.
When driving, keep your windows rolled up.
Be careful when mowing the lawn or trimming vegetation, activities that might arouse insects in a beehive or wasp nest.
Have hives and nests near your home removed by a professional.

Know what to do when you're exposed to bees:

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.

Diagnosis

If you've had a reaction to bee stings that suggests you might be allergic to bee venom, your doctor may suggest one or both of the following tests:

Skin test. During skin testing, a small amount of allergen extract (in this case, bee venom) is injected into the skin of your arm or upper back. This test is safe and won't cause any serious reactions. If you're allergic to bee stings, you'll develop a raised bump on your skin at the test site.
Allergy blood test. A blood test can measure your immune system's response to bee venom by measuring the amount of allergy-causing antibodies in your bloodstream. A blood sample is sent to a medical laboratory, where it can be tested for evidence of sensitivity to possible allergens.

Allergy skin tests and allergy blood tests are often used together to diagnose insect allergies. Your doctor may also want to test you for allergies to yellow jackets, hornets and wasps — which can cause allergic reactions similar to those of bee stings.

Treatment

For ordinary bee stings that do not cause an allergic reaction, home treatment is enough. Multiple stings or an allergic reaction, on the other hand, can be a medical emergency that requires immediate treatment.

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 medications including:

Epinephrine (adrenaline) to reduce your body's allergic response
Oxygen, to help you breathe
Intravenous (IV) antihistamines and cortisone to reduce inflammation of your air passages and improve breathing
A beta agonist (such as albuterol) to relieve breathing symptoms

Epinephrine autoinjector

If you're allergic to bee stings, your doctor is likely to prescribe an emergency epinephrine autoinjector (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 medication when pressed against your thigh. Always be sure to replace epinephrine by its expiration date.

Be sure you know how to use the autoinjector. Also, make sure the people closest to you know how to administer the drug — if they're with you in an anaphylactic emergency, they could save your life. Medical personnel called in to respond to a severe anaphylactic reaction also may give you an epinephrine injection or another medication.

Consider wearing an alert bracelet that identifies your allergy to bee or other insect stings.

Allergy shots

Bee and other insect stings are a common cause of anaphylaxis. If you've had a serious reaction to a bee sting or multiple stings, your doctor likely will refer you to an allergist for allergy testing and consideration of allergy shots (immunotherapy). These shots, generally given regularly for a few years, can reduce or eliminate your allergic response to bee venom.

Lifestyle and home remedies

If a bee stings you or your child, follow the suggestions below.

Treatment for minor reactions

If you can, remove the stinger as soon as possible, such as by scraping it off with a fingernail. Don't try to remove a stinger below the skin surface. A stinger may not be present, as only bees leave their stingers. Other stinging insects, such as wasps, do not.
Wash the sting area with soap and water.
Apply a cold compress.

Treatment for moderate reactions

The following steps may help ease the swelling and itching often associated with large local reactions:

If you can, remove the stinger as soon as possible, such as by scraping it off with a fingernail. Don't try to remove a stinger below the skin surface. A stinger may not be present, as only bees leave their stingers. Other stinging insects, such as wasps, do not.
Wash the affected area with soap and water.
Apply a cold compress.
Take an over-the-counter pain reliever as needed. You might try ibuprofen (Advil, Motrin IB, others) to help ease discomfort.
If the sting is on an arm or leg, elevate it.
Apply hydrocortisone cream or calamine lotion to ease redness, itching or swelling.
If itching or swelling is bothersome, take an oral antihistamine that contains diphenhydramine (Benadryl) or chlorpheniramine.
Avoid scratching the sting area. This will worsen itching and swelling and increase your risk of infection.

Preparing for an appointment

Bee and other insect stings are a common cause of anaphylaxis. If you've had a serious reaction to a bee sting but did not seek emergency treatment, consult your doctor. He or she may refer you to an allergy specialist (allergist) who can determine whether you're allergic to bee or other insect venom and can help you find ways to prevent future allergic reactions.

Your doctor or allergist will do a thorough physical examination and will want to know:

When and where you were stung
What symptoms you had after getting stung
Whether you've had an allergic reaction to an insect sting in the past, even if it was minor
Whether you have other allergies, such as hay fever
What medications you take, including herbal remedies
Any health problems you have

Some questions you might want to ask your doctor include:

What do I do if I get stung again?
If I have an allergic reaction, do I need to use emergency medication such as an epinephrine autoinjector (EpiPen, Auvi-Q, others)?
How can I prevent this reaction from happening again?

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