Table of Contents
After reading this article, be sure to check out our Bee
Sting Pictures in our Trauma
Bees and wasps belong to the phylum Arthropod. There are
more insects than any other living creature. They are crucially
important to the pollination of plants, specifically flowers,
fruits and vegetables.
Bees and wasps belong to the Hymenoptra family. They vary
in size and have induced fear into humans for centuries. Phobias
of insects have long been a source for people to avoid the
outdoors. This is a perfect example where education and proper
preparedness can help individuals get back to enjoying the
History of Killer Bees
Leave it to man, the most dangerous animal, to exploit nature
to try and increase his monetary status. Hence, the “killer
bee” is born. In the 1950’s in South America,
an entomologist introduced the African honey bee to Brazil
cross-breeding it with the European honey bee. The thought
was that it would be a more efficient honey producer. In result,
we have the Africanized honey bee.
These bees are much more aggressive, they attack in large
swarms, and will chase a human for greater than 1 mile. The
first escape from hives was in 1957 in San Paulo Brazil, they
have moved northward traveling 200 to 300 miles per year.
In 1993, they have been documented in Texas, Arizona, Southern
California, and as far east as North Carolina. In the year
2001 reports have been made with some speculation that they
have traveled as far north as Arkansas.
With the reality of global warming, killer bees will slowly
progress northward. Their venom is less in quantity than your
regular honey bee, and there is no difference in the chemical
substance when compared to honey bees. As of 2002 there have
been approximately 382 fatal attacks worldwide by killer bees.
Myth: After your first bee
sting reaction, future bee stings double and triple in severity.
Fact: In many research studies,
repeated stings over time actually have a lesser reaction
not an increased one.
Myth: Elderly individuals are
more susceptible to a severe reaction than middle-aged.
Fact: The older one gets, the
body's histamine production is less. Subsequently, the allergic
reaction is less. This is not to say that an anaphylactic
reaction cannot occur, although it is rare.
Myth: Bees can see and sting
in the dark.
Fact: This is partially true,
bees can sting in the dark as a stimulus response reaction.
However, they cannot see in the dark. If being chased by a
swarm of bees during the day, you can decrease their intensity
by running to a dark garage or a darkened area of a forest.
Myth: A severe anaphylactic
reaction will usually occur in the first 5 to 10 minutes after
Pathophysiology of Bee Stings
Fact: Most anaphylactic reactions
do occur in the first 15 to 30 minutes. 60% occur in the first
hour, and the remaining occur in the next 3 to 4 hours. If
there is not a severe reaction in 5 hours, the chances are
very good that one will not occur.
venom of bees, wasps and fire ants contains phospholipase
A2, hyaluronidase, apamin, meliltin, and kinins. Our body
quickly overreacts with histamine production. Histamine is
found in higher concentrations in skin, lungs, and stomach
mucosa. The release of histamine from the mast cells is usually
triggered by skin disruption, i.e. bee sting. Histamine is
a potent arterial dilator. Individuals therefore can become
hypotensive (lowering of blood pressure) and may pass out.
In the lungs you see bronchial constriction, therefore difficulty
breathing, wheezing, and in severe cases respiratory collapse.
As one ages, histamine production is less. It is rare for
the elderly to have a severe anaphylactic reaction from a
Bee Sting Symptoms
Symptoms vary from local reactions of pain, redness at the
sting site, and formation of a wheal (raised bump usually
pale in color). Localized itching is common and redness in
the first 24 hours can become as large as 12 to 18 inches
in diameter. These reactions are initially scary promoting
people to seek medical attention.
As per the Merck manual, the average person can tolerate
10 stings per pound of body wait. The average adult can withstand
approximately 1000 stings where around 500 stings can kill
a child. Anaphylaxis and death can occur from one sting if
the individual is highly allergic. Usually severe reactions
will occur in the first hour. Most will occur in the first
15 minutes. Practically all severe reactions if they are to
occur, will happen in the first 6 hours.
Many individuals have been given false information on allergic
reactions. As per Auerbach in his Wilderness Medicine text:
“There is no correlation between systemic reactions
and number of stings in the past or number of stings per incident
and severity of an allergic reaction.” “In a study
of 138 adults with a history of anaphylactic reactions, 99
had no anaphylactic reaction to later stings, 17 had more
severe reactions, and 22 had mild reactions.”
Children less than 10 years old and the elderly older than
70 have less severe reactions than younger adults.
Bee Sting Treatment
It was once thought that stingers should be scraped out with
a credit card, finger nail, or any such device. Research has
shown that the best course of action is to pull the stinger
out as soon as possible with your fingers. The remaining venom
in the sac of the stinger DOES NOT increase the reaction should
you inadvertently push more venom into your wound.
Outdoor Treatment and Prevention
During Survive Outdoor presentations,
many questions have been posed about Epi-pens. Should children
on boy scout outings have them if they have never had an allergic
reaction? Yes, we do not know and cannot predict allergic
reactions, specifically anaphylactic reactions. All scout
leaders and adults should have one in their medical kit before
trips to the outdoors. These can be prescribed by your healthcare
provider. The ABC’s, Airway, Breathing, and Circulation,
must be adhered to in that order.
Here are the steps to take when stung in
the outdoors by a bee or wasp:
- Pull stinger out.
- Cool compresses or ice.
- Diphenhydramne (Benadryl) should be given to decrease
minimal allergic reactions.
- If a severe allergic reaction occurs, you must transport
immediately and resort to basic life support.
- In addition to Benadryl, it has been shown that Cimetadine
(Tagamet) and H2 blocker can also help decrease the allergic
Healthcare Provider – Medical
If initial signs and symptoms occur
of systemic reactions, epinephrine should be administered.
- Adults – 0.3 to 0.5 mg of 1:1000
- Children – 0.01 mg/kg of 1:1000
- Diphenhydramine 25 to 50 mg IV, IM, or
- H2 – antagonist ratidine 50 mg
- Prednisone has really no acute benefit,
however will help decrease urticaria over time.
- Tetanus update if not current in the
last 10 years.
1. Paul S. Auerbach, Wilderness
2. Judith Tintanelli, Emergency
Medicine: A Comprehensive Study Guide
3. Mark H. Beers, The Merck