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INSECT BITE

Intro

Mild localized itching, swelling, or discomfort requires a call your health care provider for advice.

Worsening of local symptoms over a few days may be evidence of infection at the sting site. Pain, increased swelling and redness, and warmth suggest an infection. Call your health care provider for an appointment the same day.

If you had a reaction in the past, even if you used an epinephrine injection kit for this sting, go immediately to your medical office or hospital emergency department, whichever is closer. Even if you have treated yourself, you still need to be evaluated to make sure that your symptoms are resolving and are not recurring.

Hives or rash or swelling all over your body, difficulty breathing or swallowing, or dizziness  or fainting suggest an anaphylactic reaction  and require immediate medical attention.

  • If you have these severe symptoms or symptoms over your entire body, you should go to a hospital emergency department.
  • Do not drive yourself to the hospital.
  • If no one is available to drive you right away, call 911 for emergency medical transport. If you are able, tell the dispatcher that you are having a reaction to a sting.
  • While waiting for the ambulance, take self-treatment measures.

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Self-Care at Home

For most insect stings, home care is all that is necessary.

  • If insects are on or around you, remain calm.
  • Gently brush any insects from your skin.
  • Quietly leave the area as quickly as you can.
  • If the stinger is still lodged in the skin, as it usually is after honeybee stings, it should be removed promptly.
  • You can do this by scraping the site with a credit card or similar device, perpendicular to the skin. A fingernail can be used.
  • Pinching the stinger to pull it out is not advised, because this may inject more venom.
  • Control local swelling
  • Elevate the part of the body where the sting is located.
  • Apply ice to the area of the sting.
  • If the sting is on the hands or feet where rings or other tight-fitting jewelry is worn, these should be removed immediately before swelling develops, to avoid any compression of the blood supply to these areas.
  • Control pain: Ibuprofen (Advil) or acetaminophen (Tylenol) is usually sufficient to relieve pain.
  • Treat the itch
  • Take an antihistamine pill, such as diphenhydramine (Benadryl). This helps counteract one of the mediators of the reaction and will help control itching. Diphenhydramine is available without a prescription. Caution - this medication makes most people too drowsy to drive or operate machinery safely. It can be taken every 6 hours for the first few days, until the swelling begins to improve.
  • Hydrocortisone cream, available over-the-counter, can be applied to the site of the insect sting to relieve itching.
  • A paste of baking soda or salt and water, rubbed on the skin, may provide relief.
  • An over-the-counter lotion such as Calamine can help.
  • If a blister develops at the site, keep the area clean but do not break the blister.
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Do not be alarmed if the reaction takes 2-5 days to heal. Continue treatment until all symptoms are gone. For more severe reactions, self-treatment is not recommended. Call your health care provider or 911, depending on the severity of your symptoms. Do not attempt to drive yourself. If no one is available to drive you right away, call for an ambulance. If you have symptoms of anaphylaxis, here's what you can do while waiting for the ambulance:

  • Try to stay calm.
  • Remove yourself from the area where the insects are.
  • Take an antihistamine (1-2 tablets or capsules of diphenhydramine [Benadryl]) if you can swallow without difficulty.
  • If you are wheezing or having difficulty breathing, use an inhaled bronchodilator such as albuterol (Proventil) or epinephrine (Primatene Mist) if one is available. These inhaled medications dilate the airway.
  • If you are feeling light-headed or faint, lie down and raise your legs higher than your head to help blood flow to your brain.
  • If you have been given an epinephrine kit, inject yourself as you have been instructed. The kit provides a premeasured dose of epinephrine, a prescription drug that rapidly reverses the most serious symptoms (see Follow-up).
  • Bystanders should administer CPR to a person who becomes unconscious and stops breathing or does not have a pulse.
  • If at all possible, you or your companion should be prepared to tell medical personnel which medications you have taken today, which you usually take, and any known allergies.

Other Therapy

Allergy shots (immunotherapy) may be effective in people with severe reactions to certain insect stings.

  • Allergy shots are given in a series over a few months.
  • Each shot contains a little bit more of the insect venom antigen.
  • Ideally, the person becomes desensitized to the antigen over time.
  • Shots are effective at reducing the severity of the reaction in most people.
  • A booster shot is required every 3-5 years to maintain immunity.
  • These shots are available for bee and fire ant venoms.

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