Laboratory Studies

Diagnosis usually is confirmed by patient's history. In systemic reactions, laboratory studies may help evaluate organ damage caused by the reaction. Complete blood cell (CBC) count and blood chemistry may be needed.

Stinger removal

The stinger most commonly appears as a dark barb in the skin with attached stinging apparatus of honeybees.

People who have been stung should remove the bee stinger as quickly as possible. Removal method is not as important as rapidity because the stinging apparatus actively injects venom into the wound for 1 minute after the sting, even if the bee has been killed or knocked away from the site. Visscher and colleagues demonstrated no advantage to scraping away the stinger compared with pinching.^[16]

Forceps may be needed to remove the stinger after the venom sac has been torn away.

Treatment & Management

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Tarpy D. Africanized Honey Bees: Where Are They Now, and When Will They Arrive in North Carolina. NC State Cooperative Extension. Available at http://content.ces.ncsu.edu/africanized-honey-bees-where-are-they-now-and-when-will-they-arrive-in-north-carolina/. February 5, 2015; Accessed: September 23, 2015.
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. [QxMD MEDLINE Link].
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.
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].
Gummin DD, Mowry JB, Beuhler MC, Spyker DA, Brooks DE, Dibert KW, et al. 2019 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 37th Annual Report. Clin Toxicol (Phila). 2020 Dec. 58 (12):1360-1541. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
McGain F, Harrison J, Winkel KD. Wasp sting mortality in Australia. Med J Aust. 2000 Aug 21. 173(4):198-200. [QxMD MEDLINE Link].
Langley RL. Animal-related fatalities in the United States-an update. Wilderness Environ Med. 2005. 16(2):67-74. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Betten DP, Richardson WH, Tong TC. Massive honey bee envenomation-induced rhabdomyolysis in an adolescent. Pediatrics. 2006 Jan. 117(1):231-5. [QxMD MEDLINE Link].
Reisman RE. Unusual reactions to insect stings. Curr Opin Allergy Clin Immunol. 2005 Aug. 5 (4):355-8. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Vachvanichsanong P, Dissaneewate P. Acute renal failure following wasp sting in children. Eur J Pediatr. 2009 Jan 16. [QxMD MEDLINE Link].
Visscher PK, Vetter RS, Camazine S. Removing bee stings. Lancet. 1996 Aug 3. 348(9023):301-2. [QxMD MEDLINE Link].
Alqurashi W, Stiell I, Chan K, Neto G, Alsadoon A, Wells G. Epidemiology and clinical predictors of biphasic reactions in children with anaphylaxis. Ann Allergy Asthma Immunol. 2015 Sep. 115 (3):217-223.e2. [QxMD MEDLINE Link].
De Soto H, Turk P. Cimetidine in anaphylactic shock refractory to standard therapy. Anesth Analg. 1989 Aug. 69(2):264-5. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
[Guideline] Sturm GJ, Varga EM, Roberts G, et al. EAACI guidelines on allergen immunotherapy: Hymenoptera venom allergy. Allergy. 2018 Apr. 73 (4):744-764. [QxMD MEDLINE Link].

Media Gallery

Western paper wasp (Mischocyttarus flavitarsis) building a nest. By Sanjay Acharya (self-made at Sunnyvale, California, USA). Courtesy of Wikimedia Commons.
Yellow jacket. By Richard Bartz, Munich aka Makro Freak (Own work). Courtesy of Wikimedia Commons.
Fire ant bites. In less than 10 seconds, an unwary scientist was stung over 250 times on one leg when he carelessly knelt on a collapsed fire ant mound. The sterile pustules developed to this stage in 3 days. US Department of Agriculture. Courtesy of Wikimedia Commons.
Fire ants. US Department of Agriculture. Courtesy of Wikimedia Commons.

of 4

Author

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

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

Joe Alcock, MD, MS Associate Professor, Department of Emergency Medicine, University of New Mexico Health Sciences Center

Joe Alcock, MD, MS 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.

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.

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.