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Bee and Wasp Stings

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Early Skin Cancer Detection

An application designed to facilitate self-examination of the skin and early detection of abnormalities. Read more.

Therapeutic Management of Malignant and

Stinging Insects: Identification and Stinging Mechanisms

Insects that deliver painful stings generally belong to the order Hymenoptera. These include several groups known for their ability to inject venom.

• Vespoidea (Vespids): Common wasp (yellow jacket), hornet, and paper wasp.
• Apoidea (Bees): Bumblebee and honey bee.

The stinging mechanism, present only in the females of these insects, is located in the abdomen. It consists of a venom reservoir and a stinger, frequently barbed or pointed.

A crucial detail is that when a honey bee stings, its barbed stinger detaches from the insect's body along with the venom sac, resulting in the animal's death. Conversely, wasps do not leave their stingers embedded and can therefore sting repeatedly.

Common Symptoms of Bee or Wasp Stings

A wasp sting usually causes immediate, sharp pain that quickly subsides, although the affected area becomes red, tender, and swollen. This localized irritation, accompanied by itching or pain, can persist for several hours or even days.

The sensation caused by a bee sting is comparable to that of a wasp, but the key difference is that the bee leaves the venom sac embedded in the dermis, allowing for a continuous release of toxins.

Classification of Reactions to Insect Stings

Most people experience only mild symptoms after being stung. Nevertheless, it is essential to recognize that some individuals may develop much more severe responses or even potentially fatal reactions.

Minor Localized Reaction

This is the most common response and is characterized by mild, self-limiting symptoms:

• Redness, mild pain, or itching at the sting site that tends to disappear within a few days.
• There is a possibility that a small blister may form in the affected area.

Large Localized Reaction

In cases of a large localized reaction, the surrounding area becomes noticeably swollen and very tender to the touch. This swelling can persist for an extended period, from 48 hours up to a full week, and can sometimes be indistinguishable from a skin infection like cellulitis [1].

Although similar reactions are observed after subsequent stings, the risk of developing systemic anaphylaxis from each individual episode remains low, with reported rates below 5% [2].

Potentially Severe Systemic Reactions

Allergic reactions affecting the whole body (systemic), especially anaphylaxis, are rare but potentially fatal events. These are more likely in individuals who have been previously exposed to the sting, due to a sensitization process sensitization to the insect's venom.

• Symptoms of a systemic reaction usually manifest rapidly, starting between 10 and 20 minutes after the sting, although they can sometimes take up to 72 hours to appear.
• Clinical manifestations mirror those seen in anaphylaxis caused by other agents, including the presence of hives, generalized erythema, angioedema, potential fatal circulatory collapse, and Acute hives can present in any area of the body and usually have a widespread distribution.. The outcome can be fatal.
• The incidence The estimated incidence of anaphylaxis from bee stings in the general population is between 0.3% and 3%.[1]
• Skin toxic Toxic reactions that lead to anaphylaxis can be triggered by multiple simultaneous stings (between 50 and 100), as the large venom load strongly stimulates IgE antibody production.

Protocol for Action in Case of Bee or Wasp Stings

After a bee sting, it is crucial to remove the stinger from the skin immediately. If it is a wasp, it will not leave a stinger, so there is nothing to remove. When attempting to extract a bee stinger, avoid squeezing the venom sac with your fingers or tweezers, as this can inject more toxin. The most recommended approach is to scrape the stinger out using a flat edge, such as the side of a card.

The required medical treatment will depend directly on the severity of the individual's reaction.

• Wash the affected area with water and keep it clean.
• Avoid scratching or vigorously rubbing the area to prevent secondary infections.
• Apply a cold compress to the area to reduce swelling.
• In most cases, simple analgesia is sufficient, using over-the-counter medications like acetaminophen (paracetamol in the US) or ibuprofen.
• Administration of oral antihistamine tablets helps significantly reduce itching and inflammation.
• Certain creams Topical creams for bites or stings can provide symptomatic relief. These formulations frequently include a local anesthetic local anesthetic, an antihistamine, or a corticosteroid.

A large local reaction, characterized by considerable swelling, might warrant a short course (3 to 5 days) of oral steroids, such as prednisone, under medical supervision.

Any life-threatening reaction or case of anaphylaxis constitutes an immediate medical emergency.

• If the person shows signs of shock, difficulty breathing, or airway inflammation, administer adrenalina immediately (for example, using an auto-injector like EpiPen®), if accessible.
• In the hospital setting, it is imperative to follow Advanced Life Support (ALS) protocols.
• Individuals with a known risk of anaphylaxis must always carry an epinephrine auto-injector (EpiPen) and be properly trained, as should their family members or responsible caregivers, on how and when to use it effectively.

Late or Unusual Manifestations After Stings

On certain occasions, the after-effects of bee and wasp stings turn out to be extraordinarily long-lasting, persisting for weeks or even months. Cases of symptomatology involving

of Avoidance Strategies for Triggering Factors, sickness disease, neuritis, and encephalitis have been documented, manifesting in the days or weeks following insect stings [3]. There are even reports of secondary parkinsonism and following stings from Hymenoptera [4,5]. Some of these cases have occurred after anaphylactic reactions to the stings. after anaphylactic reactions to the stings.

Persistent wasp sting reaction

Purpuric wasp sting reaction

Infected Bee and Wasp Stings

Cellulitis and lymphangitis can occur if bacteria bacteria penetrate the break in the skin at the sting site. Such secondary requires antibiotic treatment.

Evaluation of Skin and Serum Allergies

skin tests and serological analyses serological can be performed to determine reactivity and identify those individuals susceptible to more severe reactions after insect stings. This is fundamental for identifying candidates who would benefit from venom immunotherapy (VIT).

Immunotherapy to Mitigate Reactions to Insect Stings

Venom Immunotherapy (VIT) is a highly effective treatment to protect individuals allergic to venom from sting-induced anaphylaxis [6]. Generally, it is not advised for adults who only experience skin-limited reactions (e.g., Urticaria, angioedema, or erythema).

Venom immunotherapy is usually administered by an immunologist or allergist. It consists of a series of injections containing a minimal amount of the contact allergen, allergen therapy, in this case, the insect venom. These injections are administered subcutaneously repeatedly over an extended period, frequently several years. The injected venom dose is progressively increased throughout the treatment. Finally, desensitization is achieved, which means the body becomes less reactive to the venom.

Reaction to honey bee venom from immunotherapy

Strategies to Prevent Insect Stings

There are simple measures that can be implemented to decrease the likelihood of being stung by these insects:

• Proceed with caution near wasp, bee, or hornet nests, especially in proximity to flowers, fruit trees, and trash containers.
• Be sure to cover your skin using long-sleeved clothing, long pants, and appropriate footwear.
• If a stinging insect flies over you, try to move away with slow movements, avoiding waving your arms abruptly.
• Apply insect repellent to exposed skin exposed skin; DEET is considered the most effective compound.
• Avoid walking in areas that attract wasps, bees, and bumblebees, including areas with flowering plants, exposed trash, fruit trees, or identified nests.
• Keep your food and drinks covered whenever you are outdoors.
• Try not to wear very bright colors, particularly yellow tones, if there is a probability of stinging insects nearby.
• Try not to disturb wasps and bees. If you detect a wasp nest near your residence, contact a professional pest control service for safe removal.

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