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Bees and other stinging insects, like wasps, can be found in many places so you should be careful when spending time outdoors. Some insects are quite calm and not venomous while others can bring some serious consequences to mammals they sting or bite. Although many different types of insects can inflict a venomous bite or sting, the insects most likely to cause medical problems are bees and wasps. Their sting can be quite painful and even life threatening to people allergic to their venom. A sting of a bee differs from insect bites, and the venom of stinging insects is significantly different among different species. As a result, the body's reaction to a bee sting may be different depending on the bee species. We will focus on symptoms after a honey bee sting. To be able to understand how to treat a bee sting, it is necessary to know how it happens and what are the possible consequences. While the information here refers to bee stings for convenience, it applies to stings caused by both bees and wasps.
A bee sting is a laceration or puncture wound in the skin caused by a bee. The venom in a bee or wasp sting causes a local toxic reaction in all people who get stung. In some people, this reaction is more severe, an allergic one – but only in those who have been previously sensitized by a sting. The stinging apparatus is tied to the digestive tract of the bee and consists of a barbed stinger and a sac of venom. After a bee or wasp stings, the sac contracts, dumping venom into the tissue. Since the sting is barbed, it gets pulled out, along with the venom sack and other parts, and the bee dies. Even though the bee dies, the venom takes effect soon after the sting. The sting itself should be removed quickly as leaving it in the skin increases the effects of the venom; the venom sac continues to pump venom into the wound.
The sting of a bee injects apitoxin into the victim which is accompanied by the release of pheromones alarming other bees. Apitoxin is a bitter colorless liquid which causes local inflammation and acts as an anticoagulant. If a bee is fatally injured, the release of pheromones is higher and accelerated. These pheromones alert other bees of a treat and may attract bees who will act defensively until the threat is gone. If a target enters the water, bees will wait and continue attacking when it leaves the water. The reason behind it is that alert pheromones do not wash off or dissipate easily. Because of these pheromones, a victim is in danger of being stung by multiple bees or a whole swarm, which can be deadly for people allergic to bee venom.
In the US, it is estimated that death from bee stings is 3 or 4 times more common than from snakebites. The Africanized honeybee, known as a killer bee, has reached the southern and southwestern states. These bees are more aggressive and attack in swarms, causing a more severe reaction than other bees.
Most reactions to a sting are mild or moderate and do not involve a severe reaction to the bee venom. For example, only about 3% of children experience any allergic reaction. However, some people develop severe allergic reaction and need urgent medical care. Such severe allergic reactions cause symptoms called anaphylaxis symptoms.
The symptoms of a bee sting can be grouped into four distinct groups, depending on the severity of the reaction.
Local reaction
Body-wide allergic reactions
Toxic reactions
Delayed reactions
Local reactions are the most common type of reaction to the bee sting, and they are not allergic reactions. These symptoms begin right after the sting and usually don't last very long, only a few hours. Symptoms of local reaction include swelling, pain, redness, and warmth at the site of the sting. Larger local reactions might have greater swelling that can last up to a week. Sometimes larger local reactions are associated with tiredness or nausea.
Body-wide or systemic allergic reactions occur in people who have been stung before. Following the previous stinging their body produced antibody IgE against the venom in the sting. Systemic allergic reactions rarely occur, and reactions can vary from mild skin hives to life-threatening reactions. Symptoms of systemic allergic reaction include hives and flushing of the skin and difficulty breathing. Troubles with breathing can occur because of swelling of the epiglottis and pharynx, and narrowing of the bronchial passages.
The most dangerous allergic reactions, known as anaphylaxis, usually occur in males and people under 20 years of age. The Strong allergic reaction followed by low blood pressure (hypotension), circulatory disturbances, and difficulty breathing can lead to a fatal cardiorespiratory arrest.
People who develop anaphylactic reactions are at risk of having a severe reaction to future stings. The possibility of having a severe reaction to a sting can rise up to 60%!
Toxic reactions are a result of toxins in the bee venom. Most commonly they occur after the victim has been stung multiple times at once. By getting multiple stings the amount of venom injected into the body increased so the reaction might be more severe. Symptoms include nausea, vomiting, fever, diarrhea, convulsions, headache, fainting or dizziness. Less common symptoms of toxic reactions are hives, rash and other skin symptoms. As with body-wide allergic reactions, the toxic reaction increases the chances of having anaphylactic reactions from future stings.
Delayed reactions are rare and may occur days or weeks after the sting. Detection of delayed reactions depends on the individual's medical history and condition. Symptoms can vary and may include inflammation of the brain (encephalitis), blood vessels (vasculitis), kidneys (nephritis), and nerves (neuritis).
An example of a delayed reaction is serum sickness, which occurs 7 - 10 days after the sting and may cause a rash, fever, joint pain, fatigue, swollen lymph nodes, and itching.
Upon being stung a person feels instant, sharp, burning pain lasting few seconds
Redness, swelling, pain, warmth, and itching at the site of the sting. They might peek at around 48 hours after the sting and last for up to a week.
Worse symptoms are more likely if there have been multiple stings – there can be a rash, fever, nausea, and headache. Multiple stings can be fatal for children
Some symptoms are the same as those suffered by people with a severe allergic reaction, so get urgent help just in case – these include nausea, vomiting or diarrhea, feeling dizzy or fainting, difficulty breathing and low blood pressure.
If you suspect that you might have an allergic reaction to a bee venom then seek medical attention, and there you will have a few tests to check if you are allergic. One or both of these tests might be done::
Allergy blood test - measures the amount of allergy-causing antibodies in your bloodstream as a response to bee venom
Skin test - a small amount of bee venom is injected into the skin of your arm or upper back. If you are allergic to bee venom, at the test site you will develop a raised bump. This test is completely safe and won’t cause any serious reaction.
Most bee stings can be treated without medical attention. Any treatment of a bee sting firstly requires removal of the stinger to stop the further injection of venom. Studies have shown that the amount of venom injected rises even with a delay of few seconds. After removing the stinger, the pain and swelling should be reduced with a cold compress. A topical anesthetic containing benzocaine can be used for pain relief, and menthol is an effective anti-itch treatment. Few more treatments to relieve itching are steroid cream or antihistamine.
Since bee venom is acidic, ammonia and ammonia-containing liquids are often suggested as a quick way to clean the skin and remove excess venom. An example of an ammonia-containing liquid is a window cleaner. However, neutralizing the venom is not likely to be effective because it is injected deep into the tissue. Alkali applied on the skin are unable to reach the venom so they cannot neutralize it. Some people claim such traditional treatments are effective but it is not proven they have any real physical effect on the pain. Most likely the positive effect some people experience is related to rubbing the area or placebo effect.
In people who have a mild reaction, the sting may hurt for a few hours and swelling, and itching should be gone in a week. Scratching the area should be avoided as it can increase the swelling and itching.
In some cases, the reaction covers an area greater than 7-10 centimeters (3 - 4 in) and reaction persists for over a week. If this happens, medical attention should be sought. Doctors often recommend a tetanus immunization for the sting.
A highly allergic person might suffer anaphylactic shock which can be life-threatening and requires urgent medical treatment. People who know they are allergic to bee venom might carry a self-injectable EpiPen with epinephrine (adrenaline) in case they have an anaphylactic shock.
Patients with severe allergies may benefit from allergy injections of increasing concentrations of venom which may provide protection against future stings.
Providing first aid after a bee or wasp sting can be easy if the reaction is not severe, just stay calm and don’t panic. However, stay alerted for signs of a more severe reaction that requires medical care. If you are not sure, the best option is to seek medical attention just in case. To help you out with dealing with the sting we have made a list of DOs and DON’Ts with helpful tips.
Stay with the person to watch out for signs of a severe reaction developing
Seek urgent medical help if there are signs of a severe allergic reaction
Remove the stinger quickly – honey bee stingers are barbed and usually remain in the skin, and prompt removal is needed since the injection mechanism continues
To remove the stinger, wipe over it with a piece of gauze, or scrape a finger nail, piece of card or a bank card over it
Remain calm – walk away calmly since wasps and hornets can sting again (they do not usually leave a stinger)
Wash the site of the sting with plain soap and water
Apply a cold compress – ice, frozen peas or cold cloth to reduce swelling
Offer aspirin or acetaminophen if desired to reduce pain; sprays or creams containing anesthetic and antihistamine are available from pharmacists, as are oral antihistamines for reducing swelling.
Leave the person alone – they may develop a severe reaction
Use tweezers to remove the stinger
Squeeze the stinger in an attempt to remove it – this can cause more venom to be injected
Scratch the sting – this could aggravate the problem and lead to an infection
Panic! Waving around will not help, and wasps and hornets do not usually leave a stinger – so they may sting again
Use calamine lotion, vinegar or bicarbonate of soda – these are not recommended treatments, and the aim of neutralizing the acidic venom with the latter two is pointless since the venom gets deep into the tissues
Burst any blisters that develop since this can lead to infection.
If an insect sting has led to swelling or blistering, or if signs of infection develop, such as pus, see your health care provider. A doctor may help with local swelling, itching or pain with treatments that include painkillers, topical corticosteroids and antihistamines. If the local reaction is larger and more severe, such as when the local swelling is severe, oral corticosteroids may be prescribed for a course of 3 to 5 days (for example, prednisolone). This may be in addition to painkillers and antihistamines.
The following symptoms may signal a severe allergic reaction that can be life-threatening (anaphylaxis), so if any appear following a bee or any other insect sting, emergency medical care is needed – CALL AN AMBULANCE:
Wheezing or difficulty breathing
Nausea, vomiting or diarrhea
Fast heart rate
Dizziness or feeling faint
Difficulty swallowing (dysphagia)
Confusion, anxiety or agitation.
Bees can be found anywhere so you cannot completely avoid getting stung, but you can take some actions that can help you reduce the possibility of being stung.
If you are spending a lot of time outdoors, wear shoes and socks. And if you are spending a lot of time in rural or wooden areas also wear long sleeved shirts, and long pants.
Learn to recognize bee nests and avoid them, this applies to all insects. Honey bees camp out in beehives, wasps and hornets can be found in bushes, trees, and on buildings.
Avoid wearing brightly colored clothes and perfumes with flower scent because they can attract insects.
Avoid and remove plants and vines growing around your house that attract insects.
If you have severe allergies and plan to spend a lot of time outdoors, make sure to not go alone, just in case.
Bees are amazing creatures, and they are usually not aggressive unless provoked. They can cross great distances in search of nectar and water which means that there is a high chance you might come across some bees. Their ability to sting might scare some people, but that is just their defense mechanism. If you don't disturb them or their hive, they most likely won't bother you. In case you get stung then most likely you will have a mild reaction that can be treated at home, and the symptoms will be gone in a week. If you are not sure if you are allergic, then your best bet is to ask your doctor to run some tests just to be sure. In case you notice any signs of a severe allergic reaction to a sting, seek medical attention immediately!
However, even allergies to bee venom can be managed with allergy shots that with time will help reduce the allergic reaction. If you plan on spending time outdoors, make sure to follow the prevention steps we mentioned before. With right prevention and smart approach, there is no need to be afraid of the bees. BEE CAREFUL!
Source: MedicalNewsToday, eMedicineHealth
Image: KeepingBee
