Hymenoptera Sting

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

1. See Also
   1. Envenomation
2. 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
3. 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
4. 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
5. 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
6. Complications (rare - case reports)
   1. Vasculitis
   2. Nephritis
   3. Neuritis
   4. Encephalitis
   5. Myocarditis
   6. Guillain-Barre Syndrome
7. 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
8. 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]