Fast Five Quiz: Bites and Stings

Richard H. Sinert, DO

Disclosures

April 29, 2019

Local reactions to bee and wasp stings may include the following:

  • Pain occurs immediately after sting

  • Edema is marked and may extend to 10 cm from site of envenomation

  • Bleeding may occur at site of sting

  • Pruritus is common

  • Vasodilation may produce a sensation of warmth

  • Nausea or vomiting may occur without generalization

  • If bees or wasps are swallowed, stings can cause painful swelling in the mouth or esophagus

  • Visceral pain may occur with stings in the gastrointestinal tract after ingestion of the insect

A patient's reaction to a bee or wasp sting determines the treatment required. Reactions may be graded as local, urticaria without systemic symptoms, and generalized. Emergency physicians should attempt to determine degree of reaction based on both patient history and a physical examination. Fatal allergic reactions can occur as the first generalized reaction. Far more common, however, is a fatal reaction after a previous, milder generalized reaction. The shorter the interval since the last sting, the more likely it is that a severe reaction will take place. Rapid onset of symptoms is the rule: 50% of deaths occur within 30 minutes of the sting, and 75% occur within 4 hours.

Large local reactions do not predispose patients to generalized reactions. Local reactions may be life-threatening if local swelling at the sting site compromises the airway. Local reactions to stings can cause peripheral nerve block.

Read more on bee and wasp stings.

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