Most individuals experience pain, discomfort, redness, and localized swelling after a wasp or bee sting. This type of reaction, known as a “local reaction,” typically resolves on its own within a few days without any treatment. However, if the swelling enlarges (10 cm or more) or spreads along an arm or leg, it’s advisable to see a GP, who may prescribe medication to reduce the swelling.
In more serious cases, such as stings on the face or neck that result in swelling affecting the throat, tongue, or airways, immediate medical attention is required as the airway may become blocked.
If symptoms escalate rapidly from the sting site or cause difficulty breathing, choking, or fainting, this could indicate a systemic allergic reaction (anaphylaxis). Anaphylaxis is a medical emergency that demands immediate action. Call 911 or administer an adrenaline auto-injector immediately if the person has an adrenaline auto-injector. Look for a medical alert bracelet, which might confirm the allergy.
Additionally, if you are stung on the hand and notice swelling in the face or hives across the body, this is a systemic reaction requiring urgent emergency treatment.
Types of Sting Allergic Reaction
This reaction typically persists for a few hours. The sting site may be red, painful, swollen, or itchy.
This reaction lasts for several days. The sting site becomes more painful and swollen, and itchiness may extend beyond the sting site to nearby areas.
A severe allergic reaction can begin within minutes after being stung. It can affect the entire body and trigger symptoms like dizziness (feeling lightheaded), nausea, weakness, stomach cramps, and diarrhea. It may also cause itching around the eyes, a warm sensation, coughing, hives, vomiting, and swelling. Some people report a sudden feeling of being extremely unwell, often described as a “sense of impending disaster.”
Anaphylaxis is usually characterized by:
Diagnosis and Testing
To confirm a venom allergy and identify the specific stinging insect responsible, allergists can measure allergen-specific IgE antibody levels through a simple blood test. On the other hand, a diagnostic skin prick test with insect venom(s) may be conducted.
In some cases, skin prick testing alone may not provide sufficient sensitivity. If this occurs, intradermal testing may be done, which involves injecting a small amount of highly diluted purified venom beneath the skin. This test must be carried out by an experienced professional in an allergy clinic, as it may cause minor discomfort and carries a very small risk of an additional severe reaction.
Treating Local Reactions to Stings
For stings that cause itching, pain, redness, and swelling at the site, these approaches may help:
Keep these treatments in a portable first aid kit and store them at room temperature for easy access.
Emergency Treatment for Severe Systemic Reactions to Stings
Individuals with an allergy to wasp or bee venom who experience a systemic reaction after a sting should always carry two emergency adrenaline auto-injectors (AAIs), as recommended by their doctor. It’s important to regularly practice how to use the injector to avoid any mistakes. Also, ensure the AAI kit is always readily available, and train family and friends in its use.
Two doses of adrenaline should be kept on hand, as a second dose may be required while awaiting emergency services.
Many AAI suppliers provide trainer devices, instructional videos, and alert systems to notify you when your AAI is approaching its expiration date.
Immunotherapy (Desensitisation Treatment)
Over 50% of adults who have had a systemic reaction to a sting are at high risk of experiencing a similar or more severe reaction with subsequent stings, which can be fatal. While the risk in children is lower, it remains significant.
Immunotherapy (desensitization) effectively prevents severe allergic reactions in over 95% of wasp allergy cases and approximately 80% of bee sting allergies. Even if a patient does experience a reaction after treatment, its severity is greatly reduced.
The treatment consists of weekly injections for about 12 to 15 weeks, with progressively higher concentrations of the purified insect venom to which the person is allergic. This process is safe when conducted in an allergy clinic, and patients must remain under observation for an hour after each injection to monitor for rare reactions that may require prompt treatment.
After the initial treatment phase, “maintenance doses” are administered every six to eight weeks for three to five years. Although this treatment is time-consuming, it is highly effective and available at allergy clinics.
Many people with venom allergies experience anxiety due to the fear of a fatal reaction to a subsequent sting. Immunotherapy offers significant reassurance, as it is both effective and long-term protection, often lasting for years after treatment completion.
When to Seek Further Medical Advice
Anyone who experiences a systemic reaction to a sting should visit their GP and, if necessary, request a referral to an NHS allergy clinic for further evaluation and advice. Systemic reactions can pose a future risk to health and may be life-threatening.
For local reactions, seek medical attention if you notice any of the following:
Sting Avoidance Strategies
Although insect repellents can be applied to exposed skin, they may not be effective against stinging insects. Insecticide aerosols (such as wasp sprays) are useful indoors for killing wasps but should be used cautiously to avoid inhalation, particularly around children, because of possible toxicity.
Persons with sting allergies should follow specific precautions to reduce the risk of being stung:
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