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

MOST BEE STINGS REQUIRE BASIC CARE

Question: Last week my child stepped on a bee. Her foot swelled up a bit and got red, but she was better in a few days. My mother says I should have taken her to the emergency room because she might have had an allergic reaction. I put ice on it, got the stinger out and gave her some antihistamine. Now I feel guilty. Should I have taken her to the ER?

Answer: Bee and wasp stings are very common summer injuries. When most people, including children, are stung, they only have a local reaction –- slight swelling and redness right around the sting -- like your daughter had. Unless the sting occurs on the face, these cases only require such basic care as you gave to your daughter. About three percent of people have allergic reactions to these stings, and almost one percent suffer a severe, life-threatening reaction called anaphylaxis. People suffering allergic reactions, and all people stung on the face, need immediate medical attention.

When bees and wasps sting, they inject a small amount of venom through their stingers into the victims’ skin. The honeybee’s stinger is barbed, and –- along with the venom sack -- remains embedded in the skin after the sting. Hornets and yellow jackets are not venomous, but they can usually retract their stingers and sting multiple times.

When an allergic reaction to bee or wasp venom occurs, it typically comes on within the first hour after the sting. Allergic reactions to stings are associated with hives, shortness of breath, swelling of the face, wheezing, and weakness or fainting. The hives and facial swelling are not necessarily local reactions, that is, they can occur away from the site of the sting. There are rare cases in which the severe reaction does not occur until hours after the sting, so it is always a good idea to watch a person for several hours after he or she has been stung.

About 40 deaths occur annually in the United States from bee and wasp stings. A fatal reaction is more likely to occur in a person who has previously exhibited allergic reactions to stings. Also, people stung by multiple bees are more likely to suffer a severe allergic reaction.

A local reaction like the one your child had is usually associated with redness and swelling, generally no bigger than 10 inches in diameter, as well as some pain and itching. These symptoms actually may worsen over the first few days following the sting. After that, the redness and swelling should subside naturally. If it does not, that could mean the site has become infected, in which case you should see your doctor.

Otherwise, the approach you took with your daughter -- removing the stinger, using ice bags to reduce the inflammation and administering an over-the-counter antihistamine -- was the right thing to do. In addition, it is wise to clean the sting site and watch for signs of infection. As long as the victim was not stung in the face and does not exhibit the allergy symptoms I listed above within the first few hours following a sting, emergency room treatment is not needed.

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, or via e-mail to readerquestions@familymedicinenews.org. 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 diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.