BEE AND INSECT STINGS
Allergic reactions to bee and insect stings are potentially fatal. Bee, wasp,
and insect stings cause more deaths in the United States than any other kind of
envenomation (injection of venom). Wasps and bees cause 30 to 120 deaths each
year in the U.S. Most deaths occur in people 35-45 years of age. Fifty percent
of deaths occur within 30 minutes of the sting.
Stinging insects are most active during the summer and early fall. Yellow
jackets cause over 95% of the allergic insect stings in this country. Ants sting
9.3 million people each year.
The vespids include yellow jackets, hornets, and wasps.
The apids include honeybees and bumblebees.
The formicids include the stinging ants. These ants sting repeatedly in a
circular pattern, while holding on with their mouth.
Hymenoptera are social creatures that sting to protect their nest, hive,
jackets nest in the ground, and are easily disturbed by lawn mowers and
other yard activities. They are very aggressive stinging insects. They are
attracted to picnic areas, garbage, sugary food, and soda cans.
form large paper nests in trees and shrubs.
Wasps are hairless
and have a narrow “waist.” They form paper nests under roof overhangs
and eaves of buildings. Wasps feed on nectar and arthropod larvae.
have hairy bodies, and leave their stinger behind after they sting. They are
not naturally aggressive, however. Their beehives are large. The Africanized
“killer” honeybees are more aggressive, and attack in swarms. They fly
at only 4 miles per hour, allowing most victims to flee.
fire ants build earthen mounds that may contain more than 100,000 ants.
They attack in large numbers. Infants
and elderly people are at risk for being attacked by fire ants because they
have limited mobility.
HOW DO BEES AND INSECTS STING?
Bees and wasps have a stinger that is a modified
ovipositor. They puncture the skin with a hollow stinger, and inject the
venom into the victim.
Bees leave their barbed stinger in the skin, along with the attached venom
glands, nerves, and muscles. This action eviscerates the bee and kills it.
Nearly all of the bee sting venom is injected within 10 to 20 seconds. For
this reason, it is very important to remove the stinger as soon as possible
– by any means necessary.
Vespids, on the other hand, have a smooth
stinger, which allows them to sting repeatedly.
Fire ants (Solonepsis invicta) attack in large numbers, inflicting
thousands of stings and bites to victims unable to escape. Fire ants bite
with their mandible
(mouth) – then sting repeatedly in an arc around the bite site. Their
stings develop into sterile pustules,
and then rupture. Infants often scratch open fire ant wounds, which causes
secondary infections. Severe anaphylaxis has been reported in up to 4% of
imported fire ant stings. Toxic reactions occur when a large number of ants
sting an infant or elderly person.
WHAT IS HYMENOPTERA VENOM?
The venom of winged Hymenoptera (bees, wasps, ants) contains over 30
individual components, including: proteins, peptides, biogenic amines, and
All venom allergens are proteins, and most of them are also enzymes.
The major allergens in honeybee venom are: hyaluronidase
and phospholipase A2.
The major allergens in wasp venom are:
antigen 5, histamine,
phopholipase, bradykinin, dopamine, acetylcholine, and serotonin.
Fire ant venom is 95% water-insoluble alkaloid, and 5% water-soluble
allergenic protein. The alkaloids do not cause an IgE antibody response,
Hymenoptera venom initially acts by disrupting the cell membranes of the
The vasoactive amines – hydroxytryptamine, histamine, norepinephrine,
and dopamine – are responsible for local sting reactions.
Most serious reactions are caused by true IgE allergic mechanisms that
activate mast cell degranulation.
THE BODY’S REACTION TO BEE AND INSECT STINGS
The body reacts to a Hymenoptera sting in one of the following ways:
immediate usual, large local, systemic anaphylactic, toxic, or delayed
1) Immediate usual reaction:
Pain, erythema, and swelling at the sting site. This normal reaction
resolves within a few hours. It is cause by the venom’s vasoactive amines.
2) Large local reaction:
More extensive swelling and erythema around the sting site. The reaction may
take several days to resolve. It may be misdiagnosed as cellulitis.
4) Toxic reaction:
This is the result of the physiologic effects of very high concentrations of
venom - which occurs after multiple bee, ant, or wasp stings. It usually
causes vomiting, diarrhea, headache, and fever. It may occasionally cause
hemolysis, rhabdomyolysis, or intravascular coagulation.
5) Delayed reaction:
This problem may develop several days after the sting. A child may develop
THE ANAPHYLAXIS EMERGENCY
Anaphylaxis is an extreme reaction of the immune system. It is the most
serious response to a bee or insect sting. It has very profound respiratory
and cardiovascular effects,
such as airway obstruction and severe hypotension.
Other effects of anaphylaxis include:
loss of consciousness, shock, swelling of the lips and eyes, hives, and
Anaphylaxis occurs with 0.5% to 1.5% of stings. Death from a bee or insect
sting almost always occurs within the first hour. Airway obstruction is the
most frequent cause of death from anaphylaxis.
IgE antibiotics can be produced
to a variety of allergen, including bee and insect venom. IgE antibodies are
to mast cells and circulating basophils.
to the venom leads to “mediator
release” when the mast cells and basophils degranulate. Histamine is
the most common preformed mediator in mast cells.
FIRST AID FOR BEE AND INSECT STINGS
1) Remove the
bee stinger as quickly as possible – by any means necessary. Pinching the
stinger to remove it is also an acceptable technique, since time is of the
2) Check the child’s airway, breathing, and circulation.
3) Apply cool ice packs, or apply a paste made of baking soda and vinegar.
5) Inject the child with his epinephrine auto-injector
Call your physician or 911 immediately if:
the child has difficulty breathing or swallowing,
the child collapses,
the child has extreme swelling around the eyes or lips,
the child has hives
all over the body.
HOSPITAL TREATMENT FOR BEE AND INSECT STINGS
the child’s airway, breathing, circulation, level of consciousness, and
2) Measure and record all vital signs, especially blood pressure and body
3) Administer aqueous epinephrine
(1:1000) at a dose of 0.01 mg/kg if anaphylaxis is suspected. Epinephrine is
injected intramuscularly, subcutaneously, or sublingually. This dose can be
repeated every 15 minutes if necessary.
5) Provide an initial IV bolus of 10-20 ml/kg of isotonic crystalloid, in
addition to the epinephrine and diphenhydramine.
6) The child should also receive:
intructions on avoiding stings, information on obtaining a Medic-Alert tag,
a prescription for self-administered
epinephrine, and a referral for an immunology evaluation.
PREVENTION OF BEE AND INSECT STINGS
Be very careful with food and open soda cans. Do not drink from open
beverage cans outdoors, because this attracts insects.
Avoid exposed food or garbage at picnics. Keep garage and patio areas
clean. Keep garbage cans tightly sealed.
Do not allow your child to walk barefoot or wear sandals outdoors. Give
your child shoes to wear.
Give your child a hat to wear outdoors.
Avoid wearing floral patterns or bright-colored clothes outdoors. White
and khaki are the best colors for preventing insect stings.
Avoid using hair spray, wet-smelling perfumes and colognes.
Make sure that your child avoids rapid movements and arm-flailing when
near stinging insects.
Do not use noisy equipment, such as lawn movers within 50 years of
beehives, or within 150 yards of Africanized bee colonies.
Remember that most insect repellents are not effective against stinging
An article in The Medical Journal of Australia describes a patient with
anaphylaxis as a result of S. invicta (imported fire ant) stings, and
documents his treatment.