How to treat bee and wasp stings

Insect reactions can be caused by blood-sucking insects or those with venomous stingers, which is the focus of the information here - bees in particular.

The most common reaction to an insect is a local reaction to the bite of a mosquito, but while this can spread disease, the reaction itself rarely produces serious disease.¹

Bee stings, however - and similarly wasp stings - can sometimes lead to serious illness.

Such stings can be grouped by the insects known as Hymenoptera- and the most common sting is from honeybees, but some wasps and other insects can also sting, particularly the Vespidae family of wasps.¹ Yellow jacket wasps are the major cause of allergic reactions to insect stings in the US.²

While the information here refers to bee stings for convenience, it applies to stings cause by both bees and wasps. 

Fast facts on bee stings

Here are some key points about bee and other stings. More detail and supporting information is in the body of this article.

• Bees, wasps and other insects in the Hymenoptera order of insects can sting.
• Bees leave a stinger that injects a toxic venom into the skin.
• Stings do not usually need medical attention but rare cases produce a severe allergic reaction that needs emergency care.
• Pain is the main symptom and the severity depends on the location of the sting.
• A number of steps can be taken in the home treatment of uncomplicated stings, including some dos and don'ts.

What is a bee sting?

A bee sting is a puncture wound or laceration in the skin caused by a bee.³

Insect bites and stings are common and usually only cause minor irritation.

The venom contained in a bee or wasp sting induces a local toxic reaction in all people at the site of attack.^1-3

In some people, this reaction is an allergic one - but only in those people who have been sensitized previously by a sting.^1-3

The stinging apparatus consists of a sac of venom attached to a barbed stinger. When a bee or wasp stings, the sac contracts, dumping venom into the tissue.³

In the US, it is estimated that death from bee stings is 3 or 4 times more common than from snakebites. The Africanized honeybee, or killer bee, has reached the southern states and some south-western ones. These are more aggressive and attack in swarms, causing a more severe reaction than other bees.²

The US Centers for Disease Control and Prevention (CDC) has produced a pictorial guide to stinging Hymenoptera, including ants and wasps as well as bees.

What are the symptoms of a bee sting?

Some symptoms that develop after a bee sting signal a severe allergic reaction and need urgent medical attention - go to anaphylaxis symptoms that need emergency care.

Most reactions to a sting are mild to moderate and do not involve a severe allergy - in children, for example, only about 3% experience any allergic reaction.⁴

An uncomplicated bee or wasp sting produces these symptoms:^2,5,6

• Pain at the site of the sting - instant, sharp, burning pain usually lasting a few seconds (find out the most painful place for a bee sting, or the insect with the most painful sting)
• A swollen red mark (erythema) at the site of about half an inch but up to two, which can be itchy and painful
• The swelling and redness (hives, welts) may peak at around 48 hours after the sting and last for up to a week.

Some stings produce the following symptoms:^3,5,6

• Extreme redness and swelling that enlarges up to 12 inches across
• Sometimes an entire extremity or limb can swell up but should start to go down after a few days
• Worse symptoms are more likely if there have been multiple stings - there can be a rash, fever, nausea and headache. Multiple stings can be fatal for children
• Swollen and painful joints can occur after several days in rare cases
• Some symptoms are the same as those suffered by people with a severe allergic reaction, so get urgent help just in case - these include nausea, vomiting or diarrhea, feeling dizzy or fainting, difficulty breathing and low blood pressure.

Sometimes a sting can become infected. Consult a doctor if the area affected shows a puss discharge or there is an increase in the normal pain, swelling and redness that was produced by the initial sting.⁶

Home treatment for a bee sting, and prevention

Most bee stings can be treated without medical attention. First aid for someone who has been stung by a bee or wasp includes a number of dos and don'ts.^2-4,6-9

When a honey bee stings a person, the barbed stinger is not pulled back out from the wound. The bee leaves behind not only the stinger, but also part of its abdomen, digestive tract, muscles and nerves.

DO:

• Stay with the person to watch out for any severe reaction that could develop
• Call for urgent medical help if there are signs of a severe allergic reaction
• Remove the stinger promptly if it remains - honey bee stingers are barbed and usually remain in the skin, and prompt removal is needed since the injection mechanism continues
• To remove the stinger, wipe over it with a piece of gauze, or scrape a finger nail, piece of card or a bank card over it
• Remain calm - walk away calmly since wasps and hornets can sting again (they do not usually leave a stinger)
• Wash the site of the sting with plain soap and water
• Apply a cold compress - ice, frozen peas or cold cloth to reduce swelling
• Offer aspirin or acetaminophen if desired to reduce pain; sprays or creams containing anesthetic and antihistamine are available from pharmacists, as are oral antihistamines for reducing swelling.

DON'T:

• Leave the person alone - they may develop a severe reaction
• Use tweezers to remove the stinger
• Squeeze the stinger in an attempt to remove it - this can cause more venom to be injected
• Scratch the sting - this could aggravate the problem and lead to an infection
• Panic! Waving around will not help, and wasps and hornets do not usually leave a stinger - so they may sting again
• Use calamine lotion, vinegar or bicarbonate of soda - these are not recommended treatments, and the aim of neutralizing the acidic venom with the latter two is pointless since the venom gets deep into the tissues
• Burst any blisters that develop since this can lead to infection.

Prevention

A number of practical steps can be taken to reduce the risk of being stung by a bee.^2,3,5,6,9

Floral scents - including those in perfumes and toiletries - are attractive to bees.

DO:

• Wear light-colored, smooth clothing that is not too loose
• Keep clothing clean and maintain personal hygiene - sweat may anger bees
• Wear shoes
• Remove nests near the home - but ensure a professional is engaged
• Keep areas clean, especially involving food - cover food containers and trash cans
• Keep an eye out for bees - use widely brimmed cups when drinking sweet drinks to make seeing a bee easier
• Take care with any activities such as garden trimming that could provoke a nest.

DON'T:

• Wear brightly colored and flower print clothing, or fragrances and cosmetics that have floral scents; bananas and banana-scented toiletries should also be avoided
• Wear loose clothing that can trap bees and insects
• Wear open-toed shoes
• Panic! Avoid waving arms and provoking bees and wasps
• Attempt to remove nests yourself - get a professional because many insects sting when provoked (bees are aggressive usually only when hives are attacked).

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When does a bee sting need medical care?

If an insect sting has led to swelling or blistering, or if signs of infection develop, such as pus, see your health care provider.⁶

A doctor may help with local swelling, itching or pain with treatments that include painkillers, topical corticosteroids and antihistamines.³

If the local reaction is larger and more severe, such as when the local swelling (edema) is severe, oral corticosteroids may be prescribed for a course of 3 to 5 days (for example, prednisolone). This may be in addition to painkillers and antihistamines.³

Anaphylaxis - symptoms that need emergency care

Severe allergic sting reactions are treated with epinephrine (adrenaline), either self-injected or by a doctor.

The following symptoms may signal a severe allergic reaction that can be life-threatening (anaphylaxis), so if any appear following a bee or any other insect sting, emergency medical care is needed - CALL AN AMBULANCE:⁶

• Wheezing or difficulty breathing
• Nausea, vomiting or diarrhea
• Fast heart rate
• Dizziness or feeling faint
• Difficulty swallowing (dysphagia)
• Confusion, anxiety or agitation.

Where is the most painful place for a bee sting?

Perhaps it would not be the most pressing issue when you have been stung by a bee to know where it hurts most, although there may be consolation in knowing it could have been worse.

Nonetheless, one researcher felt that it was important to learn how different sting locations around the body compared on a rating scale for pain.¹⁰

Michael Smith, PhD, of Cornell University in Ithaca, New York, selected 25 locations throughout the human body and conducted an experiment to rate the painfulness of a sting at each location caused by a honey bee.

Compared with the rating of 5 assigned to the median level of pain at the forearm, all stings were rated on a scale from 1 to 10, from low to high pain severity.

Randomly assigning which location he would allow himself to be stung next and using the same morning slot, Dr. Smith left at least 5 minutes between each sting for the pain to subside. He subjected himself to three rounds of stinging for each location, to give some consistency to the results.

The eye-watering results for the ranking of painful honey bee sting locations were, in order of worst pain first (rating out of 10):

A sting on the nostril comes out on top as the most painful location for a bee sting.

1. Nostril (9.0)
2. Upper lip (8.7)
3. Penis shaft (7.3)
4. Scrotum (7.0)
5. Palm (7.0)
6. Cheek (7.0)
7. Armpit (7.0)
8. Nipple (6.7)
9. Abdomen (6.7)
10. Middle finger tip (6.7).

The remaining ranked as follows: top of the foot (6.0), behind the ear (5.3), top of the hand (5.3), back of the knee (5.0), back of the neck (5.3), foot arch (5.0), forearm (5.0), upper thigh (4.7), wrist (4.7), lower back (4.0), buttock (3.7), calf (3.7), middle toe tip (2.3), skull (2.3), upper arm (2.3).

Obviously, two of the most painful places do not apply for women, and this was a one-man experiment, albeit with a scientific design published in a peer-reviewed journal. The author comments:

"It is possible that if other people were tested, they would not rank the painfulness of the stings in the same way, or perceive pain similarly by location.

Although these findings cannot be generalized, they are still interesting."

What is the most painful insect to be stung by?

A bee sting is clearly painful - but other insects in the same group produce a worse pain, and one scientist has produced a rating known as the "Schmidt sting pain index."

The bullet ant (Paraponera clavata) gets its name from the shot of intense pain it delivers with its venom-filled sting. It is rated as having the most painful sting in the world.

Produced by Justin Schmidt, PhD, an entomologist from the Southwestern Biological Institute in Arizona, US, it looks at the insect group hymenoptera, which includes bees, wasps and ants.

Dr. Schmidt's list of stings groups them into a rating from low to high pain from 1 to 4 - the honey bee sting produces a mid-level pain:¹¹

• Level 1 - fire ant, sweat bee
• Level 1.5 - bullhorn acacia ant
• Level 2 - honey bee, yellow jacket wasp, bald-faced hornet
• Level 3 - paper wasp, harvester ant
• Level 4 - bullet ant, tarantula hawk wasp.

References:

1.        Insect stings: clinical features and management. Bernhard Przybilla and Franziska Ruëff, Deutsches Ärzteblatt International, 2012, volume 109, issue 13, pages 238-248, doi: 10.3238/arztebl.2012.0238.

2.        Insect stings. merckmanuals.com. Robert Barish and Thomas Arnold. In: The Merck Manual, edited by Robert Porter and others. Published online by Merck & Co., accessed 13 August 2015. (Topic also covered in the consumer version.)

3.        Insect bites and stings. cks.nice.org.uk. London, UK: National Institute for Health and Care Excellence, Clinical Knowledge Summaries. Information published online, accessed 13 August 2015.

4.        Bee stings symptoms & causes. Boston, Massachusetts, US: Boston Children’s Hospital. Information published online, accessed 13 August 2015.

5.        Bee stings. mayoclinic.org. Rochester, Minnesota, US: Mayo Foundation for Medical Education and Research. Information published online, accessed 13 August 2015.

6.        Insect bites and stings. nhs.uk. London, UK: National Health Service, NHS Choices. Information published online, accessed 13 August 2015.

7.        Insects and scorpions. cdc.gov. Atlanta, Georgia, US: Centers for Disease Control and Prevention/ National Institute for Occupational Safety and Health (NIOSH). Information published online, accessed 13 August 2015.

8.        Insect bites and stings. Bethesda, Maryland, US: National Institutes of Health, MedlinePlus health topics. Information published online, accessed 13 August 2015.

9.        Hymenoptera sting. fpnotebook.com. In: Family Practice Notebook, edited by Moses S. New York, New York, US: UBM Medica LLC. Information published online, accessed 13 August 2015.

10.     Honey bee sting pain index by body location. Michael Smith, PeerJ, 2014, volume 2, e338, doi: 10.7717/peerj.338.

11.     The world's most painful insect sting. bbc.com. Zoe Gough. London, UK: British Broadcasting Corporation. Information published online, accessed 13 August 2015.

12.     Hymenoptera-sting hypersensitivity. Thomas Casale and A. Wesley Burks, New England Journal of Medicine, 2014, volume 370, pages 1,432-1,439, doi: 10.1056/NEJMcp1302681.

13.     Management of corneal bee sting. Hassan Razmjoo et al., Clinical Ophthalmology, 2011, volume 5, pages 1,697-1,700, doi: 10.2147/OPTH.S26919.

14.       Triggers and treatment of anaphylaxis: an analysis of 4000 cases from Germany, Austria and Switzerland. Margitta Worm et al.,Deutsches Ärzteblatt International, 2014, volume 111, issue 21, pages 367-375, doi: 10.3238/arztebl.2014.0367.