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11.05 Hymenoptera (Bee, Wasp, Hornet) Envenomation


Presentation

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:

What not to do:

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 .

References


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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
Mark Smith, MD
Jon Handler, MD
Michael Gillam, MD