What to Do if Someone Is Stung

When someone is stung you should:

Remove any stingers
Stingers left behind by bees should be removed immediately to minimize the amount of insect venom the sting delivers. It is important to remove the stinger in a sweeping motion—as with the edge of a credit card—instead of using tweezers to pull it out. A sweeping motion is less likely to break the stinger or push remaining venom from the stinger into the sting site (which can happen if you squeeze the stinger or try to pull it out).

Check for signs of an allergic reaction
A normal response to an insect sting is swelling, pain, and redness around the site of the sting or bite. Typically, washing the sting site with soap and water, and then applying ice to reduce the swelling is sufficient to treat a local reaction. However, physicians may prescribe antihistamines or corticosteroids to minimize discomfort if swelling is pronounced or if the location of the sting makes it especially uncomfortable.

When a person is allergic to an insect sting, the reaction is typically much more widespread and may include anaphylactic symptoms such as:

• Itching and hives
• Swelling of the throat or tongue
• Difficulty breathing
• Dizziness
• Severe headache
• Stomach cramps
• Diarrhea
• Nausea
• A sharp drop in blood pressure
• Loss of consciousness

Treat allergic reactions immediately
If an allergic individual is stung, emergency medical treatment should be sought at once. If the allergic patient has injectable epinephrine such as the EpiPen^® or EpiPen^® Jr auto-injector at hand, it should also be administered immediately to reverse the potentially deadly symptoms of anaphylaxis. Prompt administration of epinephrine is important because even seemingly mild allergic reactions can escalate to deadly anaphylaxis in minutes.²

Side effects of epinephrine may include palpitations, tachycardia (an abnormally fast heartbeat), sweating, nausea and vomiting, and respiratory difficulty. Cardiac arrhythmias may follow administration of epinephrine. Patients should ask their physician about the circumstances under which this life-saving medication should be used.

Many physicians also recommend that antihistamines such as diphenhydramine be administered to lessen the symptoms of an allergic reaction, but antihistamines should only be taken in addition to epinephrine for the treatment of anaphylaxis and should not be considered a substitute for it. Only epinephrine can halt the potentially deadly effects of anaphylaxis.

Even when epinephrine is used, severely allergic people experiencing anaphylaxis may need emergency respiratory or cardiac care, or even resuscitation if they stop breathing. In any case, when an allergic person is stung, he or she will need professional care to determine whether additional epinephrine, steroids, antihistamines, or other treatments are required. Follow-up diagnosis and care by medical professionals after self-administration of epinephrine for insect stings may be critical to recovery.

Delayed or secondary reactions do occur, and patients should remain under medical supervision for at least 4 hours after an episode of anaphylaxis.³ As many as 25% of people who experience an anaphylactic reaction will have a recurrence up to 48 hours after the initial reaction and will require further medical treatment, including additional epinephrine.^4-6 Therefore, it is essential that anyone who experiences anaphylaxis is equipped with enough self-injectable epinephrine to treat additional episodes if necessary, whether they are secondary reactions or result from future exposures to anaphylactic triggers.

References

1.       AAAAI. Health hazards of imported fire ant stings. Available at: http://www.aaaai.org.
 

2.       The Merck Manual. 16th ed. Merck Research Laboratories.1992:331.
 

3.       Wood RA. Anaphylaxis in children. Patient Care. 1997;31(13):161.
 

4.       Stark BJ, Sullivan TJ. Biphasic and protracted anaphylaxis. J Allergy Clin Immunol. 1986;78:76.
 

5.       Brazil E, MacNamara AF. "Not so immediate" hypersensitivity—the danger of biphasic anaphylactic reactions. J Accid Emerg Med. 1998;(4):252-253.
 

6.       Korenblatt, et al. 1998 ACCP meeting abstract #234: a retrospective study of the administration of epinephrine for anaphylaxis indicating need for more than one dose.
 

7.       Fact File on Anaphylaxis: Acute Allergic Reactions to Food, Medication, Insect Stings, Latex. Dey; 2000.