A big gurumommy welcome back to Dr. Larry Kagan of Westside Pediatrics (310-979-7337, www.wspeds.net). Dr. Kagan spent the summer dealing with bee stings, today he gives us some tips for how to treat a bee sting.
Domestic honey bees, Africanized “killer” bees, bumble bees, hornets, yellow jackets, paper wasps and fire ants all belong to the order Hymenoptera. These insects are capable of inflicting a venomous sting or bite resulting in significant pain and the possibility of an allergic reaction or secondary infection. The stinger of a honey bee is barbed and is often found still attached to the skin. Wasp stingers are not barbed. They are known to sting and bite multiple times during an attack and often do not leave behind a stinger or other foreign body. Hymenoptera are particularly dangerous because they live in colonies and it is therefore not uncommon to sustain multiple stings.
Fortunately, most people do not develop allergic reactions to bee or wasp stings. Local reactions (at the sting or bite site) include the rapid onset of pain, swelling, redness and itching. Although the pain should improve after an hour, it is not uncommon for the redness and swelling to enlarge to greater than 4 inches in diameter over the next 36 hours. Don’t be surprised if it takes better than a week for the symptoms to completely resolve, especially if your child has been scratching. It is often difficult to differentiate a secondary bacterial infection from a large local reaction. Secondary infections result in worsening pain, redness, swelling, pus, and/or fever. Contact your pediatrician if you are concerned about a secondary infection, if the sting occurred in the mouth or eye, or if you develop decreased urination/dark urine (especially if you were stung more than 10 times).
Caring for uncomplicated stings or bites includes:
- Remove the stinger – some experts recommend scraping the stinger out with a credit card, I consider getting it out quickly to be more important than how you get it out
- Clean the site with soap and water
- Apply an antibiotic ointment and cover with a bandaid (to reduce scratching)
- Consider Benadryl for itch and/or Ibuprofen for pain
- Alternatively you may consider hydrocortisone cream for itch and/or ice for pain
- Within the next few days get a tetanus booster if it has been more than 10 years
So, when should we worry? Severe allergic reactions can be fatal and need to be addressed immediately. An allergic reaction to a sting will result in systemic symptoms AWAY from the sting site. Possible allergic symptoms include: hives (raised itchy bumps), body itching, swelling of the face (eyes, mouth and/or throat), wheezing, shortness of breath, nausea or vomiting, anxiety, chest pain, and in severe cases difficulty breathing, low blood pressure (dizziness or fainting), and even death. If you suspect ANY of these symptoms call 911 immediately. If available, take Benadryl as soon as possible. If you have a history of a serious allergic / anaphylactic reaction and have been stung, consider using your prescribed epinephrine (Epi-Pen) while awaiting emergency medical care.
Individuals with a history of an allergic reaction should take the following precautions:
- Avoid hives and nests
- Do not swat at insects – remain calm and leave the area when insects are around
- Avoid sugary drinks, perfumes/fragrances, and bright colored clothes when outdoors
- Long sleeved shirts and pants may provide additional protection
- Have an allergy kit/EpiPen available at all times (discuss this with your pediatrician)
If you have a history of anaphylaxis or a severe allergic reaction you may consider seeing an allergy specialist for immunotherapy.