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Hymenoptera Stings

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


Hymenoptera stings account for more deaths in the United States than any other envenomation. The order Hymenoptera includes Apis species, ie, bees (European, African), vespids (wasps, yellow jackets, hornets), and ants. Although most deaths result from immunologic mechanisms, some are from direct toxicity. Severe anaphylactoid reactions occur occasionally when toxins directly stimulate mast cells. While the vast majority of stings cause only minor problems, stings cause a significant number of deaths.

A paper wasp (Randy Park, MD) A paper wasp (Randy Park, MD)

See Arthropod Envenomation: From Benign Bites to Serious Stings, a Critical Images slideshow, for help identifying and treating various envenomations. See also All About Allergies: Be Ready for Spring, to help identify a variety of allergens and symptoms.



Target organs are the skin, vascular system, and respiratory system. Pathology is similar to other immunoglobulin E (IgE)–mediated allergic reactions. Anaphylaxis may occur and is typically a result of sudden systemic release of mast cells and basophil mediators.[1] Urticaria, vasodilation, bronchospasm, laryngospasm, and angioedema are prominent symptoms of the reaction. Respiratory arrest may result in refractory cases.




United States

Ants sting 9.3 million people each year. Other Hymenoptera species account for more than 1 million stings annually. Anaphylaxis secondary to Hymenoptera envenomation affects roughly 3% of the general population.[2] Systemic reactions leading to life-threatening manifestations occurs in approximately 0.4-0.8% of children and 3% of adult patients.[3]

According the US Bureau of Labor Statistics, from 2003 to 2010, bees accounted for 52 fatal occupational injuries, wasps/yellow jackets 14, and ants 4[4] . Additionally, fatal occupational injuries involving insects, by year, are as follows[4] :

  • 2003: 6 deaths
  • 2004: 10 deaths
  • 2005: 15 deaths
  • 2006: 10 deaths
  • 2007: 11 deaths
  • 2008: 10 deaths
  • 2009: 9 deaths
  • 2010: 12 deaths


A 2009 study from Costa Rica reported on Hymenoptera sting fatalities over a 22-year period (1985-2006). The annual number of deaths varied from 0-6 (2.4 deaths/year average), with a total of 52 deaths over the study period. Most deaths were in older (>50 years) and younger (< 10 years) males.[5]

From 1979 through 1978, 7 fatalities from wasp stings were reported in Australia, all from rural areas; 5 of the 7 had a history of wasp or bee venom allergy.[6]


No race predilection exists.


Hymenoptera stings of all types are more common in males than in females, probably because of more frequent exposure.


Although most deaths from toxic reactions occur at extremes of age, frequency of bites is not age dependent. Peak incidence of death from anaphylaxis is in people aged 35-45 years.

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.

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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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