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Hymenoptera Sting
Aka: Hymenoptera Sting, Wasp Sting, Wasp, Bees, Bee sting, Yellow Jacket Sting, Fire Ant Sting
- See Also
- Envenomation
- Epidemiology
- Peak Incidence in August
- Hymenoptera are most common cause of serious venom reaction (as well as for death) in U.S.
- Systemic Allergic Reaction: 5% of patients
- Anaphylaxis: <1% of patients
- Types: Hymenoptera
- Yellow jackets and Wasps (Vespidae family)
- Attracted to food and garbage containers
- Attack without provocation
- Nest in crevasses or burrows
- Disturbance of a nest may lead to attacks (>10)
- Hornets and assorted wasps (Vespidae family)
- Nest on undersurfaces of decks and roof overhangs
- Attack in small groups (1-5) if nest disturbed
- Bumblebees and Honeybees (Apidae family)
- Not aggressive unless hives attacked
- Africanized Honeybees (Killer Bees)
- Attack in swarms of hundreds
- Pursue victims well away from the hive
- In U.S. found in Arizona, California and Texas
- Fire Ants (Formicidae family, Solenopsis species)
- Nest in the ground
- Attack in swarms when nest is attacked
- Signs: Local Reactions
- Bees/Wasps (Venom contains biogenic amines)
- Erythematous Papules develop in seconds
- Most lesions subside in 4-6 hours
- Larger areas of edema and Urticaria may develop (10%, lesions may last >48 hours)
- Some extensive local reactions persist for days
- Fire ants (Venom contains alkaloids)
- Arc shaped lesions
- Sterile Pustules develop within 24 hours
- Honeybee
- Barbed Stinger remains in skin after sting
- Injection continues until Stinger removed
- Do NOT grasp Stinger - will inject more venom
- Technique to remove Stinger
- Scrape sharp object (knife) horizontally over skin
- Drags Stinger out intact
- Signs: Systemic Reaction
- Systemic Reaction or Anaphylaxis (responsible for 17% of all anaphylactic reactions)
- See Anaphylaxis for management
- Onset of reaction within 20 minutes of sting
- Serum Sickness
- Rare complication of Insect Bite
- Occurs 7-14 days after large dose of venom
- Arthralgia and fever
- Urticaria with Angioedema
- Complications (rare - case reports)
- Vasculitis
- Nephritis
- Neuritis
- Encephalitis
- Myocarditis
- Guillain-Barre Syndrome
- Management
- General measures
- Remove Stingers still embedded in skin (avoids foreign body reaction)
- Tetanus Vaccination is not needed for Hymenoptera Stings
- Systemic Allergic Reaction or Anaphylaxis Management
- See Anaphylaxis for management
- Obtain history of prior Allergic Reaction history
- Obtain details of attack
- Location
- Number of stings
- Which type of Stinging Insect
- Local Reaction
- Ice Packs or cool compresses
- Analgesics (e.g. NSAIDs)
- Unproved efficacy of:
- Antihistamines and Corticosteroids
- Topical papain (meat tenderizer) or baking soda
- Serum Sickness
- Systemic steroids
- Antihistamines
- References
- Cowling and Ferreri (2019) Crit Dec Emerg Med 33(2): 17-25
- Kemp (1998) J Postgrad Med 103(6):88-106 [PubMed]