Most of the time, allergic reactions to stings are mild enough to treat with some basic first aid. In some cases, however, an allergic reaction is an emergency that requires immediate, professional medical attention.
The first thing to do after being stung is to remove the stinger. In many cases, the more quickly a stinger is removed, the milder the reaction. Do not pull the stinger out as this may cause more venom to be released. Instead, gently rub it out. If you’ve been stung on the hand or arm, remove any jewelry (rings, watches, bracelets, etc.) immediately. This is to prevent additional problems from developing due to any later swelling. Hold the limb above your head to reduce swelling.
Clean the affected skin with soap and water. Apply a topical ointment (like hydrocortisone cream or calamine lotion) to relieve discomfort. Cold compresses or ice packs can help reduce swelling. If irritating symptoms continue, an over-the-counter oral antihistamine can help. Pain relievers can be useful if there is pain as well as itching. If the swelling worsens, or if the site of the sting begins to look infected, consult a doctor.
If you have any symptoms that indicate an anaphylactic response, get treatment as quickly as possible. If an epinephrine auto-injection kit is available, give the medicine immediately. If not, call an emergency medical response team immediately.
Even if you have given epinephrine, call for emergency medical assistance. Some people may require additional epinephrine or intravenous fluids, oxygen, steroids, or other treatments. In some cases, an overnight stay in a hospital may be necessary to make sure all symptoms of the allergic reaction have cleared.
Antihistamines are the first-line treatments for insect stings. They can help reduce swelling, itching, and hives. First-generation antihistamines are the easiest to find, but can cause drowsiness. First-generation antihistamines include:
- brompheniramine (Dimetapp)
- dimenhydrinate (Dramamine)
- diphenhydramine (Benadryl, Sominex)
- doxylamine (Vicks NyQuil)
Second-generation antihistamines, which have fewer or no side effects, are now recommended by many doctors. Over-the-counter second-generation antihistamines include
- cetirizine (Zyrtec)
- loratadine (Alavert, Claritin)
Epinephrine (adrenaline) is a hormone that increases heart rate, contracts blood vessels, and opens air passages. It’s the primary treatment for an emergency allergic reaction like anaphylaxis. Anyone with a known severe insect sting allergy should carry an auto-injection epinephrine kit when outdoors. An epinephrine auto-injector is a combined needle and syringe that makes it easy to deliver a single dose of the medication. Three common brands of auto-injection epinephrine are Anapen, EpiPen, and Twinject.
Epinephrine is a rescue medication only. Anyone who has an anaphylactic reaction to an insect sting should be taken to see a medical professional immediately, even if they have been given epinephrine.
A severe reaction may also require a course of oral or injected steroids. Steroids are not a rescue treatment for an anaphylactic reaction because the response to a dose is not immediate. However, unlike epinephrine, steroids treat the underlying allergic inflammation, not simply the symptoms of that inflammation.
Based on your health history and diagnostic tests, your doctor may suggest immunotherapy (desensitization). This will help prevent future severe reactions. You will begin with a tiny dose of the venom to which you are allergic. By gradually increasing the dosage, your sensitivity to the venom may be reduced. You have probably heard this referred to as allergy shots. According to a review from the Cleveland Clinic, this treatment is 97 percent effective in preventing future occurrences. However, not all patients can tolerate immunotherapy