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What you need to know when stung by a wasp or bee

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BY SARAH JAYAS
Winnipeg Regional Health Authority
Wave, September / October 2016

Every fall, I see a lot of wasps or bees. Do they pose any health risks?

It depends. Stinging insects such as wasps and bees do not usually carry disease, but they can inject you with venom that can irritate your skin and prove deadly to people who are severely allergic. Sting sites may also get infected, but it is not a common problem.

What things can I do to help avoid being stung?

The best thing to do is to avoid bees and wasps whenever possible. Here are some other tips:

  • Avoid walking barefoot or wearing open-toed shoes outdoors
  • Don't wear clothing that is loose or brightly coloured
  • Avoid perfume or scented lotions or other products
  • Do not disturb beehives or wasp nests
  • Keep food and soft drinks covered, and keep garbage cans covered tightly

What should I do if I am stung?

If you are stung by a wasp or bee, try to remain calm and brush the insect away. Honeybees can sting only once because their stingers have tiny barbs that get embedded into the skin. The honeybee's stinger detaches from its body after stinging you and the bee dies. The stingers on wasps, hornets, and yellow jackets don't detach and they can sting multiple times.

You must remove a stinger quickly if one is left behind in your skin. Try to remove it within thirty seconds if possible to lessen the amount of venom released into your skin. Do not squeeze the stinger as this may release more venom. To remove the stinger, you can use any item with a flat edge like a credit card or a finger nail and scrape it off.

What is the most common kind of reaction to a sting?

Most people will have a mild reaction. There may be pain, itching, swelling and redness at the area of the sting (known as a local reaction). Severe pain or burning at the site may last one to two hours, usually followed by itching. It is normal for swelling to increase for the first 24 hours following the sting. Swelling may last up to seven days. Redness usually lasts for about three days.

About 10 per cent of people who are stung will experience redness and swelling (i.e., about four inches/10 cm or more in diameter) over one or two days before the effects slowly disappear over five to 10 days.

But it is important to note that five to 10 per cent of people who have a large reaction to a sting will develop a severe allergic reaction if stung again. If you develop a large local reaction, talk to your primary health-care provider to determine what steps, if any, you need to take if you are stung again.

What can I do to treat a local reaction?

  • Wash the area gently with soap and water.
  • Make a meat tenderizer paste with cold water. Apply it with a cotton
    ball to the sting. (Do this once for 20 minutes to neutralize the venom
    and reduce pain and swelling.) If you don't have any meat tenderizer
    available, try a baking soda paste made with cold water to relieve the
    stinging.
  • Apply a cloth-covered ice pack or cool compress for no more than 20
    minutes, four to eight times a day, to help with pain and swelling.
  • Keep the area clean and try not to scratch it.
  • Once the skin is dry and clean, apply an anti-itch medicine as
    recommended by your pharmacist and/or primary health-care provider
    and the medication's instructions.

What medications can I take for pain or swelling?

Before taking any medications, even "over-the-counter" ones, you should consult with your pharmacist and/or primary health-care provider because factors such as one's allergies, medical history, health status, possible interactions with other medications, etc. must be taken into consideration. Pregnant or breastfeeding women should especially speak to their pharmacist and/or health-care provider before taking any medications.

Your health-care provider may suggest the following over-the-counter products:

  • Oral antihistamines (such as Benadryl) for itching
  • Acetaminophen or Ibuprofen for pain relief as needed
  • 0.05% Hydrocortisone cream to the sting area three times a day to reduce inflammation.

If non-prescription treatments do not help, your pain or swelling gets worse, or the site starts to look infected, call your primary health-care provider.

Can I treat my child's sting the same way?  

Usually, you can treat your child's sting the same way as you would treat an adult's. Again, before giving your child any medications, even "over-the-counter" ones, you should ideally consult with your child's pharmacist and/or primary health-care provider because factors such as your child's allergies, medical history, health status, and possible interactions with other medications must be taken into consideration.

What happens when someone is stung by many wasps or bees?

If you are stung many times, you may have something called a systemic venom reaction. This reaction is not an allergy. It happens when there are multiple stings and therefore a larger dose of venom. Symptoms can occur within eight hours and include vomiting at first then progression to muscle breakdown, red blood cell breakdown, kidney failure, coma, and even death.

This type of reaction may occur with as little as 50 stings in an average male adult. In children, there is a general rule that this type of reaction may occur if there is more than one sting per one kilogram of body weight. Any adult or child with this many stings must be observed closely in a medical setting for around 24 hours.

Can I be allergic to a sting?

The first time you get a sting, you will usually not have an allergic reaction, but you may react to any sting after that. Allergies are a reaction by your immune system to a harmless substance that it sees as harmful. If you have had a past sting, your immune system may recognize a new sting as "harmful" and it will react. A harmless mild allergic reaction may include hives/swelling/itching (other than to the area of the sting) or stomach cramps, but rarely both if it's just a mild allergic reaction. Mild allergic reactions typically occur at least two hours after a sting.

What is the most serious reaction someone might have to a sting?

Some people may have a more severe life-threatening reaction to a sting called anaphylaxis. Anaphylaxis usually starts within 20 minutes (sometimes up to four hours) after exposure but rarely occurs several hours after exposure.

Anaphylaxis differs from mild allergic reactions in that it usually affects two or more of the following body systems:

  • Breathing
  • Circulation/heart/blood pressure
  • Gut
  • Skin
  • Brain

However, low blood pressure alone (usually causing dizziness) without other symptoms can also be anaphylaxis.

Symptoms include: 

  • Hives (skin issues) - raised, red, blotchy patches of skin that are very
    itchy
  • Swelling (aka angioedema/circulatory issues) - puffiness, usually of the face, eyelids, ears, mouth, tongue, lips, throat, hands, and/or feet
  • Difficulty breathing, trouble swallowing, wheezing, coughing, shortness of breath, chest pain, chest/throat tightness, and/or hoarse voice
  • Low blood pressure (e.g., fainting, weakness, dizziness, lightheadedness, headache, confusion, drowsiness, sluggishness, loss of consciousness, etc.)
  • Fast and/or weak pulse
  • Nausea, abdominal pain/cramping, diarrhea, and/or vomiting
  • Widespread itching, warmth, and/or redness to skin (with or without hives)
  • Cool, clammy, sometimes pale skin
  • Anxiety, sense of doom or panic (brain issues)
  • Hay-fever-like symptoms (e.g., itchy watery nose and/or eyes, sneezing, etc.)

Early symptoms should never be ignored, especially if someone has had a severe anaphylactic reaction in the past, and/or has health problems (e.g., asthma, lung or heart disease, etc.). With anaphylaxis, you can get very sick very quickly and you can have different symptoms each time you have anaphylaxis. It is important to remember that you may not always get hives with a severe reaction.

What is an EpiPen or Twinject?

It is a single-dose auto-injection kit of epinephrine. With the kit, you can give yourself a shot of epinephrine to counteract the severe allergic reaction/anaphylaxis until medical help arrives. It is not intended to be used as the sole treatment of an allergic reaction. It "buys you time" until medical help and equipment arrives.

An Epipen or Twinject is injected into the muscle in the upper outer thigh, and can be injected through clothing. Generally, for individuals less than 25 kg, a lower dose of epinephrine (i.e., a lower-dose kit) is used. A second injection of epinephrine is usually given if there is no improvement of symptoms in five to 15 minutes after the first dose was given. Antihistamines such as Benadryl and asthma medications are not recommended instead of epinephrine.

What do I do if I am having a severe allergic reaction?

Act fast. If you have an epinephrine auto-injector, use it right away while calling 911 for an ambulance. Do not try to get yourself to the hospital because you might have difficulty breathing or pass out while driving. Lie down and raise your legs above the level of your chest to increase blood flow to your heart and brain. If possible remove any stingers if still in your skin. Keep another adult, ideally one trained in CPR, nearby.

What if someone I am with might be having a severe reaction?

  • Assist them with their epinephrineauto-injector if they cannot do it themselves and call 911 right away.
  • Lay them down with their legs above the level of their heart.
  • If they are unconscious but breathing, turn them onto their side.
  • Stay with them and perform CPR if needed.

Should I get an EpiPen if I've had a severe reaction to a sting?

Yes. Tell your health-care provider about your reaction and ask for an epinephrine auto-injector kit. If it is recommended by your primary health-care provider, carry it with you at all times. Review the instructions, and know how to use it. Do not leave the kit in a car as it will not be stable in the heat or cold. Wear a necklace or bracelet that warns of your allergy and tell family, friends and co-workers what to do if you get stung. Learn about the symptoms of anaphylaxis so that you will know when to get help. And don't forget to still get outside and have fun over the summer.

Sarah Jayas is a registered nurse and team leader with Health Links - Info Santé, the provincial telephone health information service.

Wave: September / October 2016

About Wave

Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.

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