Bee stings

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 of bee stings. 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.

Minor reaction
Most of the time, signs and symptoms of a bee sting are minor and include:

* Instant, sharp burning pain at the sting site
* A red welt at the sting area
* A small, white spot where the stinger punctured the skin
* Slight swelling around the sting area

In most people, swelling and pain go away within a few hours.

Large local reaction
About 10 percent of people who get stung by a bee or other insect have a
bit stronger reaction (large local 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

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

Severe allergic reaction (anaphylaxis)
A severe allergic reaction (anaphylaxis) to bee stings is potentially
life-threatening and requires emergency treatment. About 3 percent of
people who are stung by a bee or other insect quickly develop
anaphylaxis. Signs and symptoms of anaphylaxis include:

* Skin reactions in parts of the body other than the sting area,
including hives and itching and flushed or pale skin (almost always
present with anaphylaxis)
* Difficulty breathing
* Swelling of the throat and tongue
* A weak and 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 30 to
60 percent chance of anaphylaxis the next time they're stung. Talk to
your doctor or an allergy specialist about prevention measures such as
immunotherapy 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. However, in some cases a person will disrupt a hive or swarm
of bees and get stung multiple times. 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
* Vertigo
* Feeling faint or fainting
* Convulsions
* Fever

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:

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, Twinject), 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

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 and are more
likely to die of anaphylaxis than are children. Your reaction may also
be more severe if you're taking certain medications, such as a beta
blocker.


Complications

Possible, though uncommon, complications of bee and other insect stings include:

* Anaphylaxis. A severe allergic reaction is the most dangerous
complication of a bee or other insect sting. A rapid fall in blood
pressure can lead to loss of consciousness, and can sometimes be fatal.
Anaphylaxis requires an emergency shot of epinephrine and a trip to the
emergency room.
* Toxic reaction to multiple stings can be dangerous, especially in
children. Because children are smaller than adults, fewer stings can
create high levels of venom in the bloodstream. Complications of massive
poisoning by venom (envenomation) include heart problems, rapid muscle
tissue damage (rhabdomyolysis) and kidney failure.
* Infection at the site of a sting. As with other cases when the
skin is broken, a sting site may become infected. Scratching a sting
site can increase your risk of infection.

Preparing for your 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:

* How long ago you got stung
* Where you were stung
* Exactly 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 any other allergies, such as hay fever
* What medications you take, including herbal remedies
* Any health problems you have

You also might want to ask the following questions of your doctor:

* What do I do if I get stung in the future?
* If I have an allergic reaction, do I need to use emergency
medication such as an epinephrine autoinjector (EpiPen, Twinject)?
* How can I prevent this from happening again?

Don't hesitate to ask questions during your appointment at any time that you don't understand something.

Tests and 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 purified
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 develop a raised bump
(hive) at the test location on your skin. Allergy specialists usually
are best equipped to perform allergy skin tests.
* Allergy blood test. A blood test (sometimes called the
radioallergosorbent test, or RAST) can measure your immune system's
response to bee venom by measuring the amount of allergy-causing
antibodies in your bloodstream, known as immunoglobulin E (IgE)
antibodies. A blood sample is sent to a medical laboratory, where it can
be tested for evidence of sensitivity to possible allergens.

Allergy skin tests are the most accurate tests for insect allergies. But
if the allergy skin test is negative — and your doctor still thinks you
might have a stinging insect allergy — you may need an allergy blood
test to double-check. 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.

Treatments and drugs

For most bee stings, home treatment is enough. Multiple stings or an
allergic reaction, on the other hand, can be a medical emergency that
requires immediate treatment.

Treatment for minor reactions
When a bee stings, it jabs a barbed stinger into the skin. Removing the
stinger and its attached venom sac right away will keep more venom from
being released.

* Remove the stinger as soon as you can, as it takes only seconds
for all of the venom to enter your body. Scrape the stinger out with the
edge of a credit card or a fingernail, or use a pair of tweezers. Avoid
squeezing the attached venom sac, which can release more venom.
* Wash the sting area with soap and water.
* Apply cold compresses to relieve pain and ease swelling.

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

* Remove the stinger as soon as possible.
* Wash the area with soap and water.
* Apply cold compresses.
* 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
(Chlor-Trimeton).
* Avoid scratching the sting area. This will worsen itching and swelling — and increase your risk of infection.

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 compensate for restricted breathing
* 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 will likely prescribe an
emergency epinephrine autoinjector (EpiPen, Twinject). You'll need to
carry 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 before
its expiration date, or it may not work properly.

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.

You might also 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 you've been swarmed by bees,
your doctor will likely refer you to an allergy specialist (allergist)
for allergy shots (immunotherapy). These shots are generally given on a
regular basis for a few years and can reduce or completely eliminate
your allergic response to bee venom.

Lifestyle and home remedies

Although they haven't been tested by research studies, common home remedies are sometimes used:

* Rub a wet aspirin on the sting area.
* Make a paste with baking soda or meat tenderizer and water. Leave it on the sting area for a few minutes.


Prevention

A number of prevention strategies can help you minimize your chance of getting stung by bees.

Minimize your exposure:

* Take care when drinking beverages outside. Wide, open cups may be
your best option because you can readily see what's in them.
* Avoid eating sweet foods outside.
* Tightly cover food containers and trash cans.
* Clear away garbage, fallen fruit, and dog or other animal feces (flies can attract wasps).
* Wear a long-sleeved shirt, gloves and a hat.
* Wear shoes when walking outside.
* When driving, keep your windows rolled up.
* If you're concerned about being stung, avoid activities that might
arouse insects in a beehive or wasp nest, such as mowing the lawn or
trimming vegetation. 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.