Bee Stings

Bees and Wasps belong to the Phylum Anthropda, Class Insecta and Order Hymenoptera. They are crucial to the pollination of plants, flowers, fruits and vegetables. They have long been a source of phobias and intense fear. They do account for many allergic reactions. Approximately 0.3 % to 3% of the population suffer from allergic reactions to insects. According to the CDC, from 2000-2017 they accounted for 1,109 deaths, for an annual average around 62 deaths a year. 80% of these deaths were among males.

Physiology of Bee and Wasp Stings

There are approximately 150,000 different species of Hymenoptra. They account for the largest portion of deaths related to envenomation. The most common are honey bees, wasps, yellow jackets and hornets. Fire ants are also on the rise due to global warming and their slow ascending migration from the south slowly northwards.  Killer bees or Africanized honey bees are a very aggressive species. They were introduced in Brazil in the 1950’s and have made their way to the south and southwest over decades. Fire ants are very aggressive and attach to ones skin by their mandible and then can inject multiple stings from a stinger in their abdomen. Their colonies are most common in the southeastern United States.

I will not go into extensive detail on the physiology of these stings, however, a brief overview can be helpful in understanding treatment. Venom consists of mostly low molecular weight proteins and some high molecular weight proteins. The low molecular weight proteins are responsible for histamine release from mast cells and are responsible for the local inflammation. The high molecular weight proteins are responsible for the systemic reaction and anaphalxsis. The mast cell production and basophil production are the responses to these proteins. Histamine, for the most part, runs rapid causing edema (swelling), redness, pain and increased warmth. In anaphalxsis, one will get peripheral vasodilatation ( The  arteries in your arms and legs dilate which can cause blood pressure to drop and hypertension or passing out and/or shock and death.

Signs and Symptoms

1. Immediate pain
2. Local reaction lasting minutes to hours: pain, swelling, redness, swelling and induration (hardening of the skin), warmth
3. Stinger still attached (only in bees) Scrape it or pull it out. It used to be thought that pulling the stinger out with forceps cause more infusion of venom. This has been disproven and it actually makes no significant difference and does not increase severity of symptoms by pulling it out. Just remove it.
4. Fire Ants: Local reaction is a small red area often followed by a small pustule.
5. An exaggerated or increased response defined by increased redness and large swelling in the area is usually due to an IgE mediated response. IgE is an antibody that is released with an allergic response. These reactions can last for up to a few days but resolve in about seven to ten days.
6. Anaphylaxis: Most common in the first hour. Extreme rapid acceleration of symptoms. This includes, hives, itching, angioedema  (redness over the entire body) flushing, difficulty breathing, wheezing and hypotension (lowered blood pressure and shock.

Treatment in the Outdoors

IF YOU OR  ANYONE IN YOUR PARTY IS SEVERELY ALLERGIC – ALWAYS CARRY AN EPIPEN. THERE ARE EPIPENS FOR ADULTS AND CHILDREN. GET THE SCRIPT BEFORE YOU LEAVE ON YOUR TRIP.

Uncomplicated local reactions should be treated ASAP with antihistamines H1 and H2 blockers. Examples: Famotidine (Pepcid) which is 8x stronger than Cimetadine (Tagamet) Zantac was used frequently, however it is now off the market due to the cancer scare. H1 blockers, Diphenhydramine (Benadryl) – Both administered at the same time can be very effective for counteracting an allergic response. Administration: Two Benadryl 25 mg tablets every four to six hours (Will cause drowsiness), and simultaneously give Pepcid 20 mg (For more concerning reaction: Two 20 mg tablets. Both are in my outdoor medical kit.

Large Local Reaction: Can give Prednisone which has a very positive outcome. I give Prednisone 40 to 60 mg a day for five days. Conversion is 1-2 mg per kg/daily. Script only. Prednisone can cause insomnia, increased appetite, and mild agitation. Can also raise sugar levels. Diabetics should use with caution.

Apply cool compresses or ice if available.

Anaphylaxis, ABC implementation. Airway, Breathing and circulation. Medical professionals only. If you are aware of systemic reaction to stings ask your healthcare provider for an EpiPen prescription before hiking, camping or traveling.