Derm
Hymenoptera Sting
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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
Papule
s 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
Pustule
s 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
Gene
ral measures
Remove
Stinger
s 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
Analgesic
s (e.g.
NSAID
s)
Unproved efficacy of:
Antihistamine
s and
Corticosteroid
s
Topical papain (meat tenderizer) or baking soda
Serum Sickness
Systemic steroids
Antihistamine
s
References
Cowling and Ferreri (2019) Crit Dec Emerg Med 33(2): 17-25
Kemp (1998) J Postgrad Med 103(6):88-106 [PubMed]
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