The Poison Control Center

Bees, Wasps and More

The Hymenoptera species includes bees, wasps, hornets and yellow jackets, and makes up about 90 percent of the insect-related calls to CHOP’s Poison Control Center.

Stings occur via the "stinger," a needle-like appendage at the base of the insect. The insect inserts the stinger into the skin and venom is released into the surrounding tissue. The immediate result is pain, inflammation and swelling. For most people the extent of injury stops there, but for some, the symptoms may progress to life-threatening events.

Risks of stings

If you are not allergic to Hymenoptera venom, the danger of the exposure will depend on the number of stings and the areas of the body on which you were stung. If you experience a single sting anywhere on the trunk or the limbs, the risk of reaction is low.

It is normal to experience immediate localized pain, itching, redness and swelling at the sting site. Your primary concern will be minimizing the symptoms of discomfort, which should resolve in a few hours.

If you are stung on the neck or throat area, inside your mouth or in the gastrointestinal tract (this commonly occurs when the insect is swallowed along with a beverage), there is a moderate risk for a complication. The parts of the gastrointestinal tract most likely to be affected include the throat or esophagus (food tube); the insect will not be likely to survive the acid environment of the stomach.

If the sting results in significant swelling, it could lead to airway obstruction (blockage) and trouble breathing. Contact your doctor or the Poison Control Center if such a sting occurs, and be prepared to go to the nearest emergency room if breathing becomes difficult. Multiple stings also increase your danger level and warrant the immediate attention of a healthcare professional.

Allergies to venom

An allergy to Hymenoptera venom can be one of two types: local or systemic.

Local allergic reactions

Local allergic reactions involve pain and swelling. In some cases symptoms can be extensive, may involve an entire limb and may persist for several days. Your physician may recommend antihistamines and pain medication to ease the effects of the sting. Most local allergies can be safely handled at home without much medical intervention; however, a systemic allergic reaction is a real medical emergency.

Systemic allergic reactions

Systemic allergic reactions do not depend on the amount of venom injected or the number of stings. Even a single sting can produce a serious reaction in a sensitive individual.

The reaction has a rapid onset and involves the dermal (skin), respiratory (breathing), and cardiovascular (heart) systems. The effects may include a generalized rash and swelling of the tongue or throat. This may progress to airway obstruction, shortness of breath and wheezing. The patient may experience a plunge in blood pressure and pass out.

If you know you are allergic to stings, it is advisable to wear some identification such as a Medical Alert bracelet to reveal your allergy. In addition, talk with your physician about carrying a bee sting kit containing epinephrine (EpiPen), which will quickly decrease the severe effects of an allergic reaction to a sting.

In an event of a sting, immediate transport to the nearest emergency room is essential. Call emergency medical services right away. Do not attempt to drive to the hospital.

Treatment

The first exposure to venom usually does not result in serious effects. However, subsequent exposures may prove to be a threat, so watch for any signs of allergic reaction and obtain medical attention if any serious symptoms occur. Allergic reactions to Hymenoptera stings may be frightening but they are relatively rare.

All stings, except those that require an immediate transfer to the emergency department, should be treated following these steps:

  1. Examine the area for the stinger that may be left in the skin by the insect.
  2. If the stinger is present, remove it by gently scraping over the area with a straight-edged object, e.g., a credit card, butter knife, etc.
  3. Never attempt to squeeze the stinger out of the skin, as this may inject more venom into the site.
  4. Wash the exposed area with soap and water.
  5. Apply ice (15 minutes on, 15 minutes off) to reduce swelling.
  6. Take acetaminophen for the pain.

Contact your physician or go to the emergency department if any of the following symptoms occur:

 

Reviewed by: The Poison Control Center
Date: October 2013

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