Allergy: Insect Sting (cont.)
For most insect stings, home care is all that is necessary.
- If insects are on or around you, remain calm.
- Gently brush any insects from your skin.
- Quietly leave the area as quickly as you can.
- If the stinger is still lodged in the skin, as it usually is after honeybee stings, it should be removed promptly.
- You can do this by scraping the site with a credit card or similar device, perpendicular to the skin. A fingernail can be used.
- Pinching the stinger to pull it out is not advised, because this may inject more venom.
- Control local swelling
- Elevate the part of the body where the sting is located.
- Apply ice to the area of the sting.
- If the sting is on the hands or feet where rings or other tight-fitting jewelry is worn, these should be removed immediately before swelling develops, to avoid any compression of the blood supply to these areas.
- Control pain: Ibuprofen (Advil) or acetaminophen (Tylenol) is usually sufficient to relieve pain.
- Treat the itch
- Take an antihistamine pill, such as diphenhydramine (Benadryl). This helps counteract one of the mediators of the reaction and will help control itching. Diphenhydramine is available without a prescription. Caution - this medication makes most people too drowsy to drive or operate machinery safely. It can be taken every 6 hours for the first few days, until the swelling begins to improve.
- Hydrocortisone cream, available over-the-counter, can be applied to the site of the insect sting to relieve itching.
- A paste of baking soda or salt and water, rubbed on the skin, may provide relief.
- An over-the-counter lotion such as Calamine can help.
- If a blister develops at the site, keep the area clean but do not break the blister.
Do not be alarmed if the reaction takes 2-5 days to heal. Continue treatment until all symptoms are gone.
For more severe reactions, self-treatment is not recommended. Call your health care provider or 911, depending on the severity of your symptoms. Do not attempt to drive yourself. If no one is available to drive you right away, call for an ambulance. If you have symptoms of anaphylaxis, here's what you can do while waiting for the ambulance:
- Try to stay calm.
- Remove yourself from the area where the insects are.
- Take an antihistamine (1-2 tablets or capsules of diphenhydramine [Benadryl]) if you can swallow without difficulty.
- If you are wheezing or having difficulty breathing, use an inhaled bronchodilator such as albuterol (Proventil) or epinephrine (Primatene Mist) if one is available. These inhaled medications dilate the airway.
- If you are feeling light-headed or faint, lie down and raise your legs higher than your head to help blood flow to your brain.
- If you have been given an epinephrine kit, inject yourself as you have been instructed. The kit provides a premeasured dose of epinephrine, a prescription drug that rapidly reverses the most serious symptoms (see Follow-up).
- Bystanders should administer CPR to a person who becomes unconscious and stops breathing or does not have a pulse.
- If at all possible, you or your companion should be prepared to tell medical personnel which medications you have taken today, which you usually take, and any known allergies.
Insect Allergy Treatment
The top priority for the medical team is ensuring that your breathing and blood pressure are protected.
If you are having difficulty breathing, you may be given oxygen via a tube in your nose or by face mask.
In cases of severe respiratory distress, you may be put on a mechanical ventilator. This is temporary until the effects of the reaction abate.
If your blood pressure is too low, an IV line will be placed.
You may be given saline solution through the IV to boost your blood pressure.
You may be given medication if needed to ease your breathing and/or increase your blood pressure.
- Epinephrine is the most important treatment and may be lifesaving. Epinephrine is usually given as an injection.
- H1 type antihistamine such as diphenhydramine (Benadryl) usually is given by mouth or injection to decrease the histamine reaction. This relieves the itching.
- H2 type antihistamine (H2-blocker), such as ranitidine, famotidine, or cimetidine, may be given to augment the effect of diphenhydramine.
- Corticosteroids, such as prednisone or methylprednisolone (Solu-Medrol), are often given to decrease swelling and suppress the immune response.
- If you are given antihistamines and steroids, you may be advised to continue to take them by mouth for several days after you leave the hospital.
For more information on allergy medications, see Allergy and Hay Fever Medications.
Medically Reviewed by a Doctor on 8/28/2014
Mary Buechler, MD, Deaconess-Glover
Scott H Plantz, MD, FAAEM
Francisco Talavera, PharmD, PhD
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