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Hymenoptera Stings Medication

  • Author: Hemant H Vankawala, MD; Chief Editor: Scott H Plantz, MD, FAAEM  more...
Updated: Sep 24, 2015

Medication Summary

Medications used to treat Hymenoptera stings include antihistamines (H1, H2), steroids, alpha- and beta-receptor agonists, and bronchodilators.



Class Summary

These drugs directly block effects of some venom and effects of endogenously released histamine.

Diphenhydramine (Benadryl)


Diphenhydramine is the drug of choice for all stings. It is an H1 and partial H2 receptor blocker used for symptomatic relief of allergic symptoms caused by histamine released in response to allergens.

Cimetidine (Tagamet)


Cimetidine is indicated for systemic reactions that do not respond completely to diphenhydramine, or when severity indicates a need for maximal treatment.



Class Summary

Epinephrine causes vasoconstriction, bronchodilation, and increased cardiac output. The effects of albuterol and theophylline are more focused on bronchodilation.

Epinephrine (Epi-Pen)


Epinephrine is the drug of choice for systemic reactions. It has alpha-agonist effects that increase peripheral vascular resistance and reverse peripheral vasodilation, systemic hypotension, and vascular permeability. Conversely, the beta-agonist activity of epinephrine produces bronchodilation, chronotropic cardiac activity, and positive inotropic effects. Epinephrine may be self-administered through auto-injectors.

Albuterol (Proventil, Ventolin)


Albuterol is an adjunctive treatment for bronchospasm given by nebulization, and it is a beta-agonist useful to treat bronchospasm refractory to epinephrine. It relaxes bronchial smooth muscle by action on beta2-receptors and has little effect on cardiac muscle contractility.

Theophylline (Aminophylline)


Theophylline is used to relieve bronchospasm in resistant cases. It acts to decrease muscle tone in both small and large airways in the lungs, thus increasing ventilation. Efficacy in managing bronchodilation may be due to its potentiation of exogenous catecholamines, stimulation of endogenous catecholamine release, and diaphragmatic muscular relaxation. Its effects as a bronchodilator usually are seen at levels considered to be toxic (>20 mg/dL).



Class Summary

These drugs act to stabilize lymphocytes and to reduce release of endogenous vasoactive compounds.

Methylprednisolone (Solu-Medrol, Depo-Medrol)


Methylprednisolone is indicated in all cases of generalized reaction unless contraindications exist. It is useful to treat inflammatory and allergic reactions. It may decrease inflammation by reversing increased capillary permeability and suppressing PMN activity.


Antidote, Hypoglycemia

Class Summary

Glucagon acts in the adipose tissue and liver to quickly stimulate gluconeogenesis, and thereby elevate blood glucose levels.



Glucagon is the drug of choice for severe anaphylaxis in patients taking beta-blockers (should be used in addition to epinephrine, not as a substitute).

Pancreatic alpha cells of the islets of Langerhans produce glucagon, a polypeptide hormone. It exerts the opposite effects of insulin on blood glucose. Glucagon elevates blood glucose levels by inhibiting glycogen synthesis and enhancing the formation of glucose from noncarbohydrate sources, such as proteins and fats (gluconeogenesis). It increases hydrolysis of glycogen to glucose (glycogenolysis) in the liver in addition to accelerating hepatic glycogenolysis and lipolysis in adipose tissue. Glucagon also increases the force of contractions in the heart and has a relaxant effect on the GI tract.

Dose used for anaphylaxis is higher than usual dose of 1 mg (1 U) IV/IM/SC used to treat hypoglycemia.

Contributor Information and Disclosures

Hemant H Vankawala, MD Chief Medical Information Officer, Emerus Hospital; Associate Clinical Professor, University of Texas Southwestern Medical Center; Associate Clinical Professor, Texas Tech University Health Science Center; EMS Medical Director, Big Bend National Park and Terlingua Fire and EMS

Hemant H Vankawala, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Society for Academic Emergency Medicine, Texas Medical Association, Emergency Medicine Residents' Association

Disclosure: Nothing to disclose.


Randy Park, MD Chair, Associate Professor, Department of Emergency Medicine, Denton Regional Medical Center

Disclosure: Nothing to disclose.

Carrie de Moor, MD Adjunct Faculty, John Peter Smith Hospital, Emergency Medicine; Attending Physician, 24 Hour Emergency Room, Centennial Medical Center, Del Sol Emergency Department

Carrie de Moor, MD is a member of the following medical societies: American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

James Steven Walker, DO, MS Clinical Professor of Surgery, Department of Surgery, University of Oklahoma College of Medicine

James Steven Walker, DO, MS is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American Osteopathic Association

Disclosure: Nothing to disclose.

Chief Editor

Scott H Plantz, MD, FAAEM Associate Clinical Professor of Emergency Medicine, Department of Emergency Medicine, University of Louisville School of Medicine

Scott H Plantz, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Dan Danzl, MD Chair, Professor, Department of Emergency Medicine, University of Louisville Hospital

Dan Danzl, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Kentucky Medical Association, Society for Academic Emergency Medicine, Wilderness Medical Society

Disclosure: Nothing to disclose.

  1. [Guideline] The diagnosis and management of anaphylaxis: an updated practice parameter. J Allergy Clin Immunol. 2005 Mar. 115(3 Suppl 2):S483-523. [Medline].

  2. Galera C, Soohun N, Zankar N, Caimmi S, Gallen C, Demoly P. Severe anaphylaxis to bee venom immunotherapy: efficacy of pretreatment and concurrent treatment with omalizumab. J Investig Allergol Clin Immunol. 2009. 19(3):225-9. [Medline].

  3. Hernandez M, Gonzalez S, Galindo G, Iaz A, Rodriguez P. University Hospital, et al. Reactions to hymenoptera sting in adult patients: experience in a clinical allergy/immunology service in Monterrey Mexico. World Allergy Organization Journal. 2007/11. S216-S217.

  4. Pegula S, Kato A. Fatal injuries and nonfatal occupational injuries and illnesses involving insects, arachnids, and mites. Workplace Injuries. Aug 2014. 3(17):[Full Text].

  5. Prado M, Quirós D, Lomonte B. Mortality due to Hymenoptera stings in Costa Rica, 1985-2006. Rev Panam Salud Publica. 2009 May. 25(5):389-93. [Medline].

  6. McGain F, Harrison J, Winkel KD. Wasp sting mortality in Australia. Med J Aust. 2000 Aug 21. 173(4):198-200. [Medline].

  7. Tarpy D. Africanized Honey Bees: Where Are They Now, and When Will They Arrive in North Carolina. NC State Cooperative Extension. Available at February 5, 2015; Accessed: September 23, 2015.

  8. Visscher PK, Vetter RS, Camazine S. Removing bee stings. Lancet. 1996 Aug 3. 348(9023):301-2. [Medline].

  9. De Soto H, Turk P. Cimetidine in anaphylactic shock refractory to standard therapy. Anesth Analg. 1989 Aug. 69(2):264-5. [Medline].

  10. Sokol KC, Ghazi A, Kelly BC, Grant JA. Omalizumab as a desensitizing agent and treatment in mastocytosis: a review of the literature and case report. J Allergy Clin Immunol Pract. 2014 May-Jun. 2(3):266-70. [Medline].

  11. Valkanas MA, Bowman S, Dailey MW. Electrocardiographic myocardial infarction without structural lesion in the setting of acute hymenoptera envenomation. Am J Emerg Med. 2007 Nov. 25(9):1082.e5-8. [Medline].

  12. Betten DP, Richardson WH, Tong TC. Massive honey bee envenomation-induced rhabdomyolysis in an adolescent. Pediatrics. 2006 Jan. 117(1):231-5. [Medline].

  13. Reisman RE. Unusual reactions to insect stings. Curr Opin Allergy Clin Immunol. 2005 Aug. 5 (4):355-8. [Medline].

  14. Rekik S, Andrieu S, Aboukhoudir F, Barnay P, Quaino G, Pansieri M, et al. ST Elevation Myocardial Infarction with No Structural Lesions after a Wasp Sting. J Emerg Med. 2009 Mar 26. [Medline].

  15. Vachvanichsanong P, Dissaneewate P. Acute renal failure following wasp sting in children. Eur J Pediatr. 2009 Jan 16. [Medline].

  16. Langley RL. Animal-related fatalities in the United States-an update. Wilderness Environ Med. 2005. 16(2):67-74. [Medline].

  17. Rhoades RB, Stafford CT, James FK Jr. Survey of fatal anaphylactic reactions to imported fire ant stings. Report of the Fire Ant Subcommittee of the American Academy of Allergy and Immunology. J Allergy Clin Immunol. 1989 Aug. 84(2):159-62. [Medline].

Two fire ant stings that are 24 hours old (Randy Park, MD)
A paper wasp (Randy Park, MD)
A paper wasp (Randy Park, MD)
A paper wasp (Randy Park, MD)
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