On the wings of summer come the flying hymenoptera- the bees, yellow jackets, wasps, and hornets. Athletes and active individuals who participate in outdoor activities risk being stung by venomous insects, and many may be allergic to the venom.
In the United States, approximately 50 people die annually from bee and wasp stings. Generally, these insects are aggressive only when threatened or when their hives are disrupted. Under such conditions, they sting, sometimes in swarms.
Honeybees and bumble bees have barbed stingers that become embedded in the victim's skin during the sting. After injecting their venom, these bees fly away, but their embedded stingers are torn from their bodies as they go causing them to die later. Like most venomous animals, though, honey bees and bumble bees do not release all their venom during the initial envenomation; some remains in the stinger left embedded in the victim's skin. If the stinger is not removed properly, additional venom may be released and worsen the victim's reaction.
In contrast, wasps and hornets have un-barbed stingers that do not become embedded in the victim; thus these insects can sting multiple times. Most species do not die as a result of the stinging.
The majority of stings cause only self-limited, local inflammatory reactions consisting of pain, itching, redness, and swelling. These reactions are usually more a nuisance than a medical emergency. However, local reactions may be extensive, involving a victim's entire arm or leg. When this occurs, the swelling and redness may peak 2 to 3 days after the sting and last for a week or longer. Superimposed infection may develop. However, infection of a sting is frequent unless the victim has caused a secondary infection by scratching. People who have had extensive local reactions tend to react similarly to subsequent stings.
Life-threatening reactions may involve generalized itching and hives, nausea and vomiting, wheezing, malaise, fever, conjunctivitis, and low blood pressure. Bee-sting victim's who have anaphylactic (shock) reactions develop swelling in the larynx (voice box), difficulty speaking, tightness in the throat or chest, wheezing, shortness of breath, difficulty breathing, and chest pain. People may be stung in unusual locations, such as inside the mouth, the external ear canal, in the eye or may inadvertently swallow a bee.
People who have a history of systemic reaction should carry a bee sting kit (Ana-Kit Epipen) at all times. Such kits typically contain adrenaline and an antihistamine, which should be used immediately. Of course, emergency medical care should be promptly obtained even if the kit is used.
In the case of a bee sting, check the victim for generalized flushing, rapid heart beat, and speaking or breathing difficulty. If present, these are ominous signs that signal the need for emergency medical care. Then check the victim's pulse, breathing, and blood pressure and look to see if the bee's stinger is still in the victim's skin. If so, remove it by gently flicking or scraping it out with the edge of a credit card, jackknife blade, or other sharp-edged object. Don't try to remove the stinger by hand or with tweezers; this may squeeze more venom into the victim's skin. After removing the stinger, cleanse the area with soap and water.
After cleansing, apply ice intermittently (20 minutes on and 1 to 2 hours off and repeat) to reduce swelling and pain. When using ice, remember to place a towel or similar material between the skin and the ice pack to protect against frostbite. Topical pastes made of unseasoned meat tenderizer or baking soda may be helpful.
Because stings are painful, some type of analgesic may be needed. Over-the-counter medication, such as acetaminophen (Tylenol), aspirin, or ibuprofen (Motrin, Advil, Nuprin), is usually adequate. A topical steroid cream such are hydrocortisone, may help combat local swelling or itching.
From Physician and Sports Medicine, August 1991.
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