Bee sting: symptoms and management

Many of you may have got bee sting experience on first hand or at least heard it from your near and dear ones. 

Bee sting can produce a local skin reaction or a life threatening emergency situation which you may need immediate medical intervention.

Here we will further discuss bee sting and its effect and management needed for the same.

About honey bees

Honey bees are widely known insects of family Hymenoptera. There are different types of honey bees across the world according to geographic regions.

yellow and black bee

Honey bees are social insects and they live in large groups in a honeycomb. They have a well structured functional society in their honeycomb.

These insects collect nectar with their stings and they can use those stings for attacking someone if they feel dangerous for them.

When their honeycomb is disturbed or they feel someone is a threat to them they usually attack in a group in large numbers.

When they sting they can secrete many chemicals in your bodies. Some of them are histamines and enzymes and are venomous. 

Symptoms of bee sting

As we discussed earlier in the event of bee sting, you get your dose of histamines and venomous enzymes injected in your skin.

Bee sting can produce symptoms by multiple mechanisms like allergic reaction and non allergic symptoms produced by the bee venom. 

Allergic symptoms occur usually within minutes of bee stings and Histamine present in bee sting induces those allergic reactions. Additionally Some antigens present in bee sting induce allergic reactions which are IgE-mediated reactions.

In the paragraphs below we will further discuss symptoms of the bee sting.

Allergic symptoms

Allergic symptoms can be very mild to very severe life threatening reactions in case of bee sting. According to severity and time of occurrence they are classified as follows:

Simple local reaction

Mildest form of allergic reactions with bee sting are local reactions and they are called simple local reactions.

In this form of reaction there is local itching and burning sensation within a few minutes if bee sting.

In a few minutes of bee sting local reactions called hives may appear. Hives are local bumps at the site of the bee sting.

These bee sting hives may appear reddish and with localized swelling less than 10 cm area.

Left untreated these local hives may subside on their own in a few hours or if a person is allergic these may worsen to form a widespread skin reaction and even life threatening systemic reaction. 

Widespread skin reaction

This type of skin reaction too occurs within a few minutes to hours of bee sting in a person allergic to bee sting.

Widespread skin reaction is called so when localized skin reaction covers areas of skin more than 10 cm in size.

Wide spread skin reaction, symptoms can appear away from the location of the sting. The entire skin may have hives and itching and burning sensation.

Lower layer of the skin may get involved and become swollen called angioedema.

Systemic symptoms

If the person has a severe allergic tendency to bee sting he/she may experience severe symptoms of allergy systemically.

These symptoms can occur in a few minutes to few hours of bee sting episodes.

They include symptoms like cough, cold, breathlessness, tightness of chest and wheezing sound from the chest.

Person with this reaction may have a rapid heart rate or slow heart rate and low blood pressure and die if not treated. Person may faint and become unconscious within a few minutes to a few hours of bee sting. This is anaphylactic reaction.

Delayed reactions

Sometimes in few people bee sting symptoms may appear after many days to weeks. They are delayed reactions and they are serum sickness.

Non allergic symptoms

Bee sting also releases some venom at the site of the sting. This venom apart from allergic reaction can also cause non allergic symptoms by their chemical nature.

Bee sting manifests as nausea, vomiting, diarrhea and abdominal pain and fever. These symptoms may be allergic or non allergic.

Additionally bee venom causes swelling around the area of the bee sting. This swelling is generally caused by the venomous nature of the chemicals in the bee sting.

Management of symptoms

Symptoms of the bee sting are managed based on the severity and nature of the symptoms.

Mild local symptoms may not need any treatment and subside on its own in a few hours.

Extensive skin reactions and systemic allergic symptoms needs management with anti allergic medicines.

Antihistamines

These are anti allergic medicines and they can be given orally or by injection. They can reverse the allergic symptoms caused by the bee sting.

Hydroxyzine, promethazine, loratadine, cetirizine, chlorpheniramine maleate are some of them that can be used for this purpose.

They may cause sedation as a side effect.

They can be used in all types of allergies like local reactions, extensive skin reactions and severe allergic systemic symptoms.

Steroids 

These are anti allergic and immunosuppressants. They reduce the allergy and inflammation of the bee sting.

They can be useful when given orally as well as by injection route. Depending on the severity of symptoms your doctor may prescribe you orally or by injection.

They are very useful in extensive skin reactions and also in severe systemic allergic symptoms.

Adrenaline/epinephrine

This very strong anti allergic medicine and antidote of histamine. It can reverse the symptoms of severe allergic reactions.

This is life saving medicine in case of severe allergies like anaphylaxis. 

Your doctor uses it by injection route intramuscular or intravenous as needed by the situation. Those who have a tendency of severe allergies should carry Epipen, an epinephrine auto injector for use in case of emergency.

Anti inflammatory medicines

As we have discussed earlier bee stings may induce inflammation locally or systemically your doctor may prescribe you anti inflammatory medicine like Combiflam.

Non allergic symptoms

Non allergic symptoms are treated depending on their severity and nature of involvement. Gastrointestinal symptoms are treated with oral rehydration solution or if needed by intravenous fluids to treat the dehydration.

Non allergic symptoms usually subside on their own within a few hours to days. Only supportive treatment is needed till they subside.

Investigations needed for bee sting

Investigations for bee sting are useful in cases of severe allergic reactions and if the immunotherapy like desensitization is planned.

Following are some important tests to detect the allergens in bee sting:

Skin prick test

In this skin prick test, your doctor applies the allergens in bee sting on your skin and pricks the skin with a small needle or instruments like that.

They observe you and your injection site skin for around half an hour. Those areas to which you were given allergen show blebs are helpful to identify the allergen.

Readymade available kits, allergy panels for insect bites are useful for this purpose.

Additionally your allergist may order the serum IgE levels allergen specific and eosinophil levels to further evaluate you.

Immunotherapy for bee sting

If you have a history of getting severe allergic reactions after bee sting there are strong chances that you will get equally strong or stronger allergic reactions in future.

Immunotherapy helps to modify the response of your immune system to allergen in future thus protecting you from allergic reaction.

Desensitization

Desensitization is a technique of immunotherapy. Your allergist can give this treatment. After identifying the allergen in bee sting, he injects you small doses of that allergen under observation.

Subsequently doses of allergen are increased and your immune response is modified by this technique and you are protected from severe life threatening allergic reaction in future.

Precautions with bee sting

It is always good to take the following precautions if you are going in an area where bee sting is likely.

  • Wear clothes covering your skin fully.
  • Do not disturb the honeycomb as far as possible.
  • If you are allergic to bee sting you should carry Epinephrine auto injector Epipen so that it can be used in emergency if needed.
  • If you are allergic to bee sting you may also be likely allergic to other insect bites.
  • shift the immediately to nearest healthcare facility if you see extensive or severe allergic reaction.



<span class="has-inline-color has-luminous-vivid-orange-color">Dr Yatin Bhole MBBS DCh DNB</span>
Dr Yatin Bhole MBBS DCh DNB

This article was written by Dr Yatin Bhole who is practicing Pediatrician at Bhole Children Clinic, Ravet. This post is for general information and before applying it on yourself, you should meet your doctor or meet us in person.



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