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Insect bites and stings

Bee sting; Bites - insects, bees, and spiders; Black widow spider bite; Brown recluse bite; Flea bite; Honey bee or hornet sting; Lice bites; Mite bite; Scorpion bite; Spider bite; Wasp sting; Yellow jacket sting

Insect bites and stings can cause an immediate skin reaction. The bite from fire ants and the sting from bees, wasps, and hornets are most often painful. Bites caused by mosquitoes, fleas, and mites are more likely to cause itching than pain.

Insect and spider bites cause more deaths from venom reactions than bites from snakes.

Considerations

In most cases, bites and stings can be easily treated at home.

Some people have extreme reactions that require immediate treatment to prevent death.

Certain spider bites, such as the black widow or brown recluse, can cause serious illness or death. Most spider bites are harmless. If possible, bring the insect or spider that bit you with you when you go for treatment so it can be identified.

Symptoms

Symptoms depend on the type of bite or sting. They may include:

  • Pain
  • Redness
  • Swelling
  • Itching
  • Burning
  • Numbness
  • Tingling

Some people have severe, life-threatening reactions to bee stings or insect bites. This is called anaphylactic shock. This condition can occur very quickly and lead to rapid death if not treated quickly.

Symptoms of anaphylaxis can occur quickly and affect the whole body. They include:

  • Chest pain
  • Face or mouth swelling
  • Difficulty swallowing
  • Difficulty breathing
  • Fainting or lightheadedness
  • Abdominal pain or vomiting
  • Rash or flushing

First Aid

For severe reactions, first check the person's airways and breathing. If necessary, call 911 and begin rescue breathing and CPR. Then, follow these steps:

  1. Reassure the person. Try to keep them calm.
  2. Remove nearby rings and constricting items because the affected area may swell.
  3. Use the person's EpiPen or other emergency kit, if they have one. (Some people who have serious insect reactions carry it with them.)
  4. If appropriate, treat the person for signs of shock. Remain with the person until medical help arrives.

General steps for most bites and stings:

Remove the stinger by scraping the back of a credit card or other straight-edged object across the stinger. Do not use tweezers -- these may squeeze the venom sac and increase the amount of venom released.

Wash the site thoroughly with soap and water. Then, follow these steps:

  1. Place ice (wrapped in a washcloth) on the site of the sting for 10 minutes and then off for 10 minutes. Repeat this process.
  2. If necessary, take an antihistamine or apply creams that reduce itching.
  3. Over the next several days, watch for signs of infection (such as increasing redness, swelling, or pain).

Do Not

Use the following precautions:

  • DO NOT apply a tourniquet.
  • DO NOT give the person stimulants, aspirin, or other pain medicine unless prescribed by a health care provider.

When to Contact a Medical Professional

Call 911 or your local emergency number if someone with a sting has the following symptoms:

  • Trouble breathing, wheezing, shortness of breath
  • Swelling anywhere on the face or in the mouth
  • Throat tightness or difficulty swallowing
  • Feeling weak
  • Turning blue

If you had a severe, bodywide reaction to a bee sting, your provider should send you to an allergist for skin testing and therapy. You should receive an emergency kit to carry with you wherever you go.

Prevention

You can help prevent insect bites and stings by doing the following:

  • Avoid rapid, jerky movements around insect hives or nests.
  • Avoid perfumes and floral-patterned or dark clothing.
  • Use appropriate insect repellents and protective clothing.
  • Use caution when eating outdoors, especially with sweetened beverages or in areas around garbage cans, which often attract bees.
  • If you have severe allergies to insect bites or stings, you should have an emergency kit and an EpiPen. Make sure your friends and family know how to use it if you have a reaction.

References

Boyer LV, Binford GJ, Degan JA. Spider bites. In: Auerbach PS, Cushing TA, Harris NS, eds. Auerbach's Wilderness Medicine. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 43.

Elston DM. Arthropods and leeches. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 359.

Otten EJ. Venomous animal injuries. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 55.

Suchard JR. Scorpion envenomation. In: Auerbach PS, Cushing TA, Harris NS, eds. Auerbach's Wilderness Medicine. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 44.

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      Review Date: 10/16/2017

      Reviewed By: Jesse Borke, MD, FACEP, FAAEM, Attending Physician at FDR Medical Services/Millard Fillmore Suburban Hospital, Buffalo, NY. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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