By Martha A. Simpson, D.O., M.B.A.
Assistant Professor of Family Medicine
Ohio University College of Osteopathic Medicine

“NORMAL” STING REACTION CAN INCLUDE LOCALIZED SWELLING AND FEVER

Question: My son got stung by a bee on his hand. He got some swelling of the hand and arm, but he also ran a low-grade fever and had pain in his elbows and knees. Can a bee sting do this? Should I worry about any long-term effects?

Answer: This is the season for bee and other venomous insect stings. Your body’s response can range from almost nothing at all to severe, life-threatening reactions that doctors call anaphylaxis. Prevention is by far the best therapy, and there are several measures you can take to avoid insect stings.

Stinging insects are attracted to specific odors and fragrances. Food and garbage containers are alluring to yellow jackets, who will attack without provocation. Perfume, cologne, and open soda containers are appealing to hornets and wasps. Many of these “stingers” can also be attracted by fragrances in hair spray and hair gels.

Finally, brightly colored clothing, especially with a floral print can be a magnet for stinging insects. These critters aren’t real smart and can easily mistake you for a flower when you’re decked out in this kind of garb.
About 5 percent of the population is allergic to stings of bees, ants and wasps. These membrane-winged insects are collectively called “hymenoptera.” This name is derived from the Greek words "hymen" meaning membrane and "ptera" meaning wings. About 1 percent of people will have severe allergic reactions to stings by hymenoptera. This is what I referred to earlier as an anaphylactic reaction.

A “normal” reaction to an insect sting is some redness, pain and swelling at the site of the sting. At times, the affected area may be fairly extensive and be accompanied by fever, swollen glands and joint pain later on. This is apparently what your son experienced. The joint pain and fever sometimes doesn’t develop until seven to 14 days after the sting, but this is rare.

The potentially life-threatening anaphylactic reaction, on the other hand, is usually evident within twenty minutes of the sting. Signs of this severe reaction can include hives, itching or swelling in areas other than the sting site, throat constriction, difficulty breathing, tongue swelling, nausea, vomiting and fainting.
If you are around someone who has this kind of reaction to an insect sting, call an ambulance and get him or her to the hospital at once. People that are severely allergic should carry medications like epinephrine and benadryl with them at all times and wear a medical alert tag. There are allergy kits that your doctor can prescribe.

If you have only a mild body response to an insect-sting, I’d recommend applying ice to the area to help minimize the spread of the reaction. You might also want to try over-the-counter antihistamines, like benadryl, to help reduce swelling. Applying a paste made of baking soda paste or meat tenderizer to the site can help relieve the pain from the sting. Generally, these localized sting reactions resolve without consequence in a few days. But remember, prevention is always better than treatment.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnosis and recommend treatment for any medical conditions. Past columns are available online at http://www.FamilyMedicineNews.org.