Sometimes a patient comes to a hospital emergency
department immediately after a painful sting because he is
alarmed at the intensity of the pain or worried about
developing a serious life threatening reaction. Sometimes he
seeks help the next day because of swelling, redness, and
itching. Parents may not be aware that their child was stung
by a bee and be concerned only about the local swelling.
Erythema soon after the sting, with varying degrees of
localized edema, develops. Often there is a central punctate
discoloration at the site of the sting, or, rarely, a
stinger may be protruding. A delayed hypersensitivity
reaction will produce varying degrees of edema which can be
quite dramatic when present on the face. Tenderness and,
occasionally, ascending lymphangitis can occur.
What to do:
Scrape away the stinger with the back edge of a scalpel
blade or a long fingernail.
Examine the patient for any signs of an immediate,
systemic, allergic reaction (anaphylaxis), such as
decreased blood pressure, generalized urticaria or
erythema, or wheezing.
Apply a cold pack to an acute sting to give pain relief and
reduce swelling.
Observe the patient with an acute sting for approximately
an hour to watch for the rare
anaphylaxis.
Reassure patient who has come in after 12-24 hours that
anaphylaxis is no longer a problem.
Prescribe hydroxyzine (Atarax) 50mg qid for itching.
If an ascending lymphangitis is present, treat the patient
with an appropriate antibiotic for 10 days (e.g.,
cephadryl (Duricef) lgm qd, cephalexin 500mg tid,
dicloxacillin 500mg qid)
If an extremity is involved, have the patient keep it
elevated and instruct him that the swelling may worsen if
the hand or foot is held in a dependent position. This
swelling may continue for several days. Severe hand swelling
may be prevented or reduced by placing the patient in a
splint and compression dressing. Promptly remove any rings
in cases of hand stings (see).
What not to do:
Do not belittle the patient's complaint or make him feel
guilty about his visit.
Do not send the patient with an acute sting out of the ED
less than one hour after the sting.
Do not apply heat, even if an infection is suspected--the
swelling and discomfort will worsen.
Discussion
Bee stings are very painful and frightening. There are many
misconceptions about the danger of bee stings, and many
patients have been instructed unnecessarily to report to an
ED immediately after being stung. Many of these people have
only suffered localized hypersensitivity reactions in the
past and are not at a significantly greater risk than the
general public for developing anaphylaxis. Besides the
immediate relief of pain for the acute sting, we have little
more than reassurance to offer these patients.
Although it is most prudent to treat an ascending
lymphangitis with an antibiotic, it should be realized that
after a bee sting the resultant local cellulitis and
lymphangitis is usually a chemically mediated inflammatory
reaction.
Histamine is one of many components of hymenoptera venom:
antihistamines may benefit the sting victim .
