Hymenoptera Sting

Aka: Hymenoptera Sting, Wasp Sting, Wasp, Bees, Bee sting, Yellow Jacket Sting, Fire Ant Sting

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II. Epidemiology

  1. Peak Incidence in August
  2. Hymenoptera are most common cause of serious venom reaction (as well as for death) in U.S.
    1. Systemic Allergic Reaction: 5% of patients
    2. Anaphylaxis: <1% of patients

III. Types: Hymenoptera

  1. Yellow jackets and Wasps (Vespidae family)
    1. Attracted to food and garbage containers
    2. Attack without provocation
    3. Nest in crevasses or burrows
      1. Disturbance of a nest may lead to attacks (>10)
  2. Hornets and assorted wasps (Vespidae family)
    1. Nest on undersurfaces of decks and roof overhangs
    2. Attack in small groups (1-5) if nest disturbed
  3. Bumblebees and Honeybees (Apidae family)
    1. Not aggressive unless hives attacked
  4. Africanized Honeybees (Killer Bees)
    1. Attack in swarms of hundreds
    2. Pursue victims well away from the hive
    3. In U.S. found in Arizona, California and Texas
  5. Fire Ants (Formicidae family, Solenopsis species)
    1. Nest in the ground
    2. Attack in swarms when nest is attacked

IV. Signs: Local Reactions

  1. Bees/Wasps (Venom contains biogenic amines)
    1. Erythematous Papules develop in seconds
    2. Most lesions subside in 4-6 hours
    3. Larger areas of edema and Urticaria may develop (10%, lesions may last >48 hours)
    4. Some extensive local reactions persist for days
  2. Fire ants (Venom contains alkaloids)
    1. Arc shaped lesions
    2. Sterile Pustules develop within 24 hours
  3. Honeybee
    1. Barbed Stinger remains in skin after sting
      1. Injection continues until Stinger removed
      2. Do NOT grasp Stinger - will inject more venom
    2. Technique to remove Stinger
      1. Scrape sharp object (knife) horizontally over skin
      2. Drags Stinger out intact

V. Signs: Systemic Reaction

  1. Systemic Reaction or Anaphylaxis (responsible for 17% of all anaphylactic reactions)
    1. See Anaphylaxis for management
    2. Onset of reaction within 20 minutes of sting
  2. Serum Sickness
    1. Rare complication of Insect Bite
    2. Occurs 7-14 days after large dose of venom
    3. Arthralgia and fever
    4. Urticaria with Angioedema

VI. Complications (rare - case reports)

  1. Vasculitis
  2. Nephritis
  3. Neuritis
  4. Encephalitis
  5. Myocarditis
  6. Guillain-Barre Syndrome

VII. Management

  1. General measures
    1. Remove Stingers still embedded in skin (avoids foreign body reaction)
    2. Tetanus Vaccination is not needed for Hymenoptera Stings
  2. Systemic Allergic Reaction or Anaphylaxis Management
    1. See Anaphylaxis for management
    2. Obtain history of prior Allergic Reaction history
    3. Obtain details of attack
      1. Location
      2. Number of stings
      3. Which type of Stinging Insect
  3. Local Reaction
    1. Ice Packs or cool compresses
    2. Analgesics (e.g. NSAIDs)
    3. Unproved efficacy of:
      1. Antihistamines and Corticosteroids
      2. Topical papain (meat tenderizer) or baking soda
  4. Serum Sickness
    1. Systemic steroids
    2. Antihistamines

VIII. References

  1. Cowling and Ferreri (2019) Crit Dec Emerg Med 33(2): 17-25
  2. Kemp (1998) J Postgrad Med 103(6):88-106 [PubMed]

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Related Studies

Ontology: Bees (C0004923)

Definition (MSH) Insect members of the superfamily Apoidea, found almost everywhere, particularly on flowers. About 3500 species occur in North America. They differ from most WASPS in that their young are fed honey and pollen rather than animal food.
Definition (MSHCZE) Hmyz z nadčeledi Apoidea, který se nachází téměř všude, obzvláště na květech. V Severní Americe se vyskytuje asi 3500 druhů. Od většiny VOS se liší tím, že své potomstvo krmí spíše medem a pylem než živočišnou potravou.
Concepts Eukaryote (T204)
MSH D001516
SnomedCT 106820008, 31141000009100, 28482008
Swedish Bin
Czech včely
Finnish Mehiläiset
Russian PCHELY, ПЧЕЛЫ
English Bees, bee, bees, Family apoidea - bee (organism), Superfamily Apoidea (organism), Apoidea, Superfamily Apoidea, Bee, Family apoidea - bee, Bee (organism), Bee, NOS
Croatian PČELE
French Abeilles
Polish Pszczoły
Spanish familia apoidea - abeja (concepto no activo), familia apoidea - abeja, Jalea Real, abeja (organismo), abeja, Abejas
Norwegian Bier
Portuguese Geleia Real, Abelhas
German Bienen
Italian Api
Dutch Bij, Bijen
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Wasps (C0043041)

Definition (MSH) Any of numerous winged hymenopterous insects of social as well as solitary habits and having formidable stings.
Definition (PSY) Any of numerous social or solitary winged hymenopterous insects.
Concepts Eukaryote (T204)
MSH D014863
SnomedCT 88030006
English Wasps, wasps, wasp, Wasp, Wasp (organism), Wasp, NOS
Swedish Getingar
Finnish Ampiaiset
Russian OSY NASTOIASHCHIE, OSY, ОСЫ, ОСЫ НАСТОЯЩИЕ
Croatian OSE
French Guêpes
Polish Osy
Czech sršňovití, vosovití, vosy
Norwegian Vepser
Spanish avispa (organismo), avispa, Avispas
German Wespen
Italian Vespe
Dutch Wesp, Wespen
Portuguese Vespas
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Wasp sting (C0413119)

Concepts Injury or Poisoning (T037)
SnomedCT 157931003, 210984001, 241819002
Dutch wespensteek
French Piqûre de guêpe
German Wespenstich
Italian Puntura di vespa
Portuguese Picada de vespa
Spanish Picadura de avispa, picadura de avispa (trastorno), picadura de avispa
Japanese スズメ蜂刺傷, ｽｽﾞﾒﾊﾞﾁｻｼｷｽﾞ, ｽｽﾞﾒﾊﾞﾁｼｼｮｳ
Czech Vosí bodnutí
English sting wasp, stings wasps, wasp sting, Sting;wasp, stings wasp, Wasp sting, Wasp sting (disorder)
Hungarian Darázscsípés
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Bee sting (C0413120)

Concepts Injury or Poisoning (T037)
SnomedCT 157930002, 210984001, 241820008
Dutch bijensteek
German Bienenstich
Italian Puntura d'ape
Portuguese Picada de abelhas
Spanish Picadura de abeja, picadura de abeja (trastorno), picadura de abeja
Japanese 蜂刺傷, ﾊﾁｼｼｮｳ, ﾊﾁｻｼｷｽﾞ
French Piqûre d'abeille
English bee sting (diagnosis), injury caused by bee sting, bee sting, Sting;bee, bee stings, Bee Stings, Bee sting, Bee sting (disorder)
Czech Včelí bodnutí
Hungarian Méhcsípés
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Yellow jacket causing poisoning and toxic reactions (C0867896)

Concepts Injury or Poisoning (T037)
English Yellow jacket causing poisoning and toxic reactions
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Hymenoptera sting (C1274548)

Concepts Injury or Poisoning (T037)
SnomedCT 403142004
English Hymenoptera sting (disorder), Hymenoptera sting
Spanish picadura de himenópteros (trastorno), picadura de himenópteros
Derived from the NIH UMLS (Unified Medical Language System)

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