Bee Stings and Venom Allergies

Bee stings are painful for everyone, but for some people — those with venom allergies — stings carry a special risk of a severe allergic reaction.

What should you do if your child is stung, and how can you tell if your child has a venom allergy? Joel Fiedler, MD, an attending physician with the Allergy Program at Children’s Hospital of Philadelphia (CHOP), offers some practical guidance.

What to watch for if your child is stung by a bee

First, Dr. Fiedler explains that what we commonly refer to as “bee stings” include, for allergists, stings by honey bees, bumblebees, yellow jackets, wasps and hornets. These insects are not all bees, but they inject similar venom into the body when they sting. Fire ants can also deliver venomous stings.

“When most people are stung by an insect, they develop local swelling in the area of the sting,” says Dr. Fiedler. This can be painful, and the swelling can sometimes be dramatic — extending along the entire upper arm, for example. But if the swelling is confined to the area of the sting, it is not a sign of venom allergy. Only when a sting in the mouth or throat causes breathing problems is a local swelling reaction reason for a trip to the emergency room.

It’s when reactions are seen in other parts of the body that you need to be concerned about venom allergy. After a sting, Dr. Fiedler advises that you monitor your child for signs of reaction unconnected to the site of the sting. These may include:

• Significant hives or itchiness away from the sting site
• Swelling of the tongue or throat
• Difficulty breathing
• Dizziness or a dazed condition (seeming “out of it”)
• Nausea, cramps, vomiting, diarrhea or other stomach complaints

In severe reactions, a drop in blood pressure can cause a child to lose consciousness.

“If you notice any of these symptoms, seek medical help immediately,” Dr. Fielder says. “It’s not an overreaction to bring your child straight to the nearest emergency room.” There, your child will be closely observed and treatment can be given to address any life-threatening symptoms.

Treating sting reactions

If your child shows signs of or is diagnosed with a venom allergy, the immediate treatment after a sting is an injection of epinephrine, such as from an EpiPen^®.

After a sting that results in an allergic reaction, once the emergency has passed, you should have your child seen by an allergist — a doctor with special expertise in allergies. The allergist can advise on future risks and help you protect your child’s health.

Extreme local reactions to stings can be treated with steroids. If your child is stung in the mouth or throat and the swelling restricts breathing, they should be quickly taken to the closest emergency department. Steroids may also be given to provide relief when local swelling is particularly uncomfortable.

Other treatments for the discomfort and swelling of a local reaction to a sting include rubbing meat tenderizer, an aluminum-based deodorant, or a baking soda paste on the sting. Cold packs or ice cubes on the sting can also help, as can over-the-counter steroid cream (1% hydrocortisone) and antihistamines.

Protecting your child from dangerous reactions to stings

If your child is diagnosed with a venom allergy, your allergist will likely prescribe a supply of auto-injectable epinephrine, such as an EpiPen^®. The doctor will explain how to inform caregivers and school staff about the risk to your child, and when they should use the medication.

In extreme cases, your doctor may suggest venom immunotherapy, a series of allergy shots given over a long period of time, that can ultimately eliminate the risk of life-threatening reactions to stings.

Even if your child has had only local reactions to bee stings in the past, that does not mean they are safe from dangerous allergic reactions in the future. Repeated insect stings can result in a venom allergy as your child grows older.

Play it safe by keeping your child away from bees and other stinging insects. Be careful when eating, cooking, or drinking sweet drinks outdoors, as all can attract insects. Keep food covered until you are ready to eat. Avoid going barefoot in areas where bees may be feeding or nesting. If bees are nearby, slowly and calmly move away.  

If your child is stung by a bee, remove the stinger as soon as possible to stop the release of additional venom. Look for a black dot in the center of the sting. If it projects above the surface, scrape it out by running the edge of a credit card over it or lift it out with a piece of sticky tape.