Bee/ wasp sting is a common form of venomous sting especially amongst individuals working in bee farms where bees are cultivated for honey. Bee sting can be life threatening with multiple bee stings causing skin blisters, introduction of venom which gets into the blood stream that can cause severe anaphylactic shock. The venom contains toxic enzymes which increase capillary permeability responsible for the swelling and skin blisters after bee/ wasp sting, haemolysis which is the destruction of red blood cells, allergic and anaphylactic reactions. The stinger of the honey bee is barbed and so is left behind in the skin with the venom sac which then continues to contract and envenom the body.
The stinger in bees is attached to its abdomen and after a bee sting, the stinger with part of the bee’s abdomen; muscles and other tissues are left on the victim. This can lead to the death of the bee especially honey bees. The toxins in bee sting are melittin and histamine which are responsible for the local and systemic effects that are seen after a bee sting.
Clinical features of bee/wasp sting
Within a few minutes of the sting, symptoms start and in multiple stings, deaths may occur within 15-30 minutes if prompt medical care is not given. Severe reaction is seen in patients who have had a previous reaction to stings.
However, most stings are usually mild causing few symptoms but every case of bee/ wasp sting should be treated adequate to prevent delayed reactions from the bee sting. Symptoms of bee/ wasp stings may include:
- Anorexia, nausea and vomiting
- Intense local pain with generalized urticaria
- Feeling of intense heat throughout the body
- Swelling around the site of sting
- Generalized pruritus and urticaria (hives)
- Abdominal cramps
- Joint swellings
- Facial swelling and excessive tearing
- Hypotension from anaphylactic shock which occurs from generalized dilatation of large veins in the body leading to pooling of blood within these blood vessels. This affect the amount of blood returned to the heart and thus the amount of blood pumped from the heart is significantly reduced
- Dyspnea and difficulty inbreathing from spasm of the airway and edema (swelling) of the glottis.
- Loss of consciousness, irritability, nervousness, confusion and dizziness
In susceptible patients, symptoms appear within a few seconds and death may occur in 2 minutes. First aid treatment of bee/ was sting is life saving and can reduce death caused by these stings.
First aid treatment of bee/ wasp sting
- ‘Safety first’, this is the keyword in every emergency treatment as the victim and the first aider should be safe. The victim should be removed immediately from the site of bee stings to a safe place to prevent more stings. It is important to note that bees secrete pheromone which tend to attract other bees
- With the aid of a tweezers, the stinger is removed gently from the skin. This reduces the amount of venom that is absorbed by the body. Wash the area with mild soap and clean water
- Observe the patient for signs and symptoms of severe anaphylactic reaction
- Ice packs should be applied to the affected area(s) to reduce inflammation, swelling and pain
- If the sting was in the hand, remove rings and bracelets because tight fitting jewelries become difficult to remove after considerable swelling and there may occlude the blood vessels supplying the affecting fingers or hand leading to ischemia and gangrene
- Topical pain creams and antihistamine helps to reduce swelling and pain. There should be applied on the affecting areas and the skin surrounding the sting site. Baking soda and hydrocortisone cream also helps in soothing the itchy skin
- Administer systemic antihistamine e.g. diphenhydramine (Benadryl) or chlorpheniramine to relieve anaphylactic symptoms
- Skin swelling and pain may last for few days after a bee sting
In severe anaphylactic shock, emergency treatment should be instituted without delay. Call 911 or the emergency number as applicable to the location.
- Loose tight fitted clothing and jewelries
- Begin CPR following the standard guidelines for performing CPR
- Turn the patient to the recovery patient if the patient is breathing spontaneously to prevent choking and aspiration
- Injection of epinephrine should be administered if available. Epinephrine is currently available as an auto-injection which can be administered intramuscularly to the patient
- Quickly transfer the patient to the nearest hospital for expert management.