Hymenoptera Sting

Aka: Hymenoptera Sting, Wasp Sting, Wasp, Bees, Bee sting

1. Epidemiology
   1. Peak Incidence in August
   2. Hymenoptera most common cause of serious venom reaction
      1. Systemic Allergic Reaction: 5% of patients
      2. Anaphylaxis: <1% of patients
2. Causes
   1. Yellow jacket Wasps
      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
      1. Nest on undersurfaces of decks and roof overhangs
      2. Attack in small groups (1-5) if nest disturbed
   3. Bumblebees and Honeybees
      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 (Solenopsis species)
      1. Nest in the ground
      2. Attack in swarms when nest is attacked
3. Signs: Local Reactions
   1. Bees/Wasps (Venom contains biogenic amines)
      1. Erythematous Papules develop in seconds
      2. Larger areas of edema and Urticaria may develop
      3. Lesions subside in 4-6 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
4. Signs: Systemic Reaction
   1. Systemic Reaction or Anaphylaxis
      1. 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
5. Complications (rare - case reports)
   1. Vasculitis
   2. Nephritis
   3. Neuritis
   4. Encephalitis
   5. Myocarditis
   6. Guillain-Barre Syndrome
6. Management
   1. Local Reaction
      1. Ice Packs
      2. Analgesics
      3. Unproved efficacy of:
         1. Antihistamines and Corticosteroids
         2. Topical papain (meat tenderizer) or baking soda
   2. Systemic Allergic Reaction or Anaphylaxis Management
   3. Serum Sickness
      1. Systemic steroids
      2. Antihistamines
7. References
   1. Kemp (1998) J Postgrad Med 103(6):88-106 [PubMed]