Stinging Insect Reactions

At Austin Family Allergy and Asthma, we evaluate and treat patients for insect sting reactions.

Normal Reactions

In the summer many people are stung by bees, wasps, hornets, yellow jackets or fire ants (yes, fire ants have a stinger). Although reactions may be uncomfortable, most are not serious and do not require emergency treatment.  In Central Texas, fire ants are the most common stings folks encounter.

Common reactions at the site of the sting include:

  • Stinging
  • Burning
  • Itching
  • Redness
  • Swelling
  • Pain

Fire ant stings tend to burn a lot (hence the name ‘fire ant’) and usually develop a small pimple or pustule the day after the sting that may last up to one week. Although this looks like a pimple, it is not infected, and antibiotics are not usually required.

Even a large amount of swelling tends to respond to conservative treatment as outlined below. Reactions do not generally worsen with future stings. However, any sting can result in a serious reaction.

Treatment

  • If a stinger is present, immediately remove it. Don’t squeeze it; some stingers, including those left by honey bees, contain more venom. Instead, scrape it out with the edge of something like a credit card.
  • Wash the area with soap and water, and apply a cold compress or ice pack.
  • Take an over-the-counter antihistamine such as Benadryl, Zyrtec or Claritin to relieve itching.
  • Take Tylenol or ibuprofen for pain.
  • A cream containing pramoxine (such as Aveeno Anti-Itch, Sensitive Sarna or Gold Bond) can be soothing.
  • Topical cortisone creams (such as Cortaid) may lessen swelling and irritation.
  • Try not to scratch, which can break open the skin and possibly lead to an infection.
  • Avoid creams containing Benadryl (diphenhydramine) or neomycin (Neosporin) as these sometimes cause allergic skin reactions.
  • If the sting site looks infected, over-the-counter bacitracin or polysporin ointment can be applied several times a day.

See a physician if swelling persists or is very large, the area of the sting becomes significantly infected (oozing, crusting, increased redness, fever, etc.) or you feel ill. Most sting reactions resolve within a few days.

Serious Sting Reactions

Some people become sensitive to insects stings and may be at risk for serious or life-threatening reactions. Symptoms that suggest serious sensitivity usually start within minutes of the sting and include:

  • Hives or itchy rash all over
  • Giant swelling distant from the site of the sting, like on face, lips or tongue
  • Trouble breathing, coughing, wheezing or shortness of breath
  • Throat tightness, airflow blockage, hoarseness or trouble swallowing
  • Rapid pulse, dizziness, fainting or shock

Anyone experiencing these symptoms after a sting should call 911 for immediate help and transfer to an emergency room. A person who has had a serious reaction to a sting should carry auto injectable epinephrine with them at all times. Epinephrine stops progression of a reaction and begins to reverse symptoms within minutes. The quicker epinephrine is given, the less likely a severe reaction.

Treatment

  • Remove stinger if present and apply icepack.
  • Inject epinephrine; it may be necessary to inject 10 minutes later if the first dose does not improve the situation.
  • Call 911 or immediately transport to emergency room.
  • Take Benadryl or over-the-counter antihistamine for itching. Please note that Benadryl is not a substitute for epinephrine and will not stop a serious reaction.

Anyone with a history of a serious allergic reaction to a stinging insect should see a Board-Certified Allergist for evaluation. Allergists are experts in advice about avoiding stings and treatment of reactions. Allergy testing can determine sensitivity and the potential for future serious reactions. A sensitive person who has experienced a serious reaction has a 60 percent or greater chance of a serious reaction with future stings.

Fortunately, allergy shots for stinging insects can reduce the chance of future reactions to less than two percent.

Successful management of insect stings involves the three As!

Allergist! Get tested to confirm; review risks of future stings and emergency action plan; venom immunotherapy (allergy shots) is over 95% effective in patients with insect venom allergy.

Avoid!

Adrenalin! Always have epinephrine available.

Insect stings are unpredictable, don’t put yourself at risk, call us at 512-346-7936.