Bee sting

Disease Description (Causes and Symptoms)

• Definition: When stung by a bee (honeybee, wasp, etc.), venom is injected through the stinger, which may cause a local inflammatory reaction (pain, redness, swelling, itching) or a systemic hypersensitivity reaction (anaphylaxis).
• Pathophysiology: Bee venom consists of various components, including melittin, phospholipase A2, hyaluronidase, and histamine, which can cause cell membrane damage (hemolysis), release of inflammatory mediators, and increased vascular permeability. Repeated exposure may trigger a specific IgE-mediated hypersensitivity reaction that can progress to anaphylaxis.
• Main symptoms
  • Local reaction: Immediate pain, redness, swelling, itching, blister formation, etc.
  • Large or severe local reaction: Swelling over a wide area or persistent pain.
  • Systemic reaction (suspected symptoms): Hives, difficulty breathing (wheezing, chest tightness), dizziness or fainting (hypotension), abdominal pain or vomiting, impaired consciousness, etc. → Immediate emergency treatment is required.
• Time of occurrence: Incidents are more frequent from summer to early autumn, when bees are active (especially August–September).

Treatment Methods

• First aid (at the scene)
  • Stinger removal: Remove the stinger by scraping it out with a credit card or similar object. Squeezing it or pulling it out with tweezers is not recommended because this may compress the venom sac and inject more venom.
  • Cold compress: Apply a cold compress at 10–15-minute intervals to relieve swelling and pain.
  • Pain and itching: Oral analgesics (acetaminophen, NSAIDs) and antihistamines (such as cetirizine) may be used. Topical steroid ointment can relieve itching.
• Hospital/medical facility treatment
  • Local reaction only: Conservative treatment (observation, analgesics, antihistamines, and topical steroids) often leads to improvement.
  • In cases of anaphylaxis (systemic symptoms) (emergency)
    • Administer intramuscular epinephrine (IM) immediately (usual adult dose: 0.3–0.5 mg IM; children: 0.01 mg/kg, maximum 0.3 mg). Reassess at 5–15-minute intervals if repeated administration is needed.
    • Secure the airway, provide oxygen, and administer large-volume intravenous fluids (in cases of hypotension).
    • Antihistamines (H1 and H2 may be used in combination), corticosteroids (to maintain normal blood pressure and prevent recurrence), and, if necessary, intubation and airway management.
    • Observation: To monitor for a secondary (biphasic) reaction after anaphylaxis, observation for at least 4–6 hours (24 hours in severe cases) is recommended.
  • Multiple stings (several dozen or more) or severe toxic reaction: Hospital admission for observation and blood tests (to check for muscle injury, hemolysis, and kidney function abnormalities) may be necessary, along with inpatient treatment.
• Prevention and long-term management
  • If bee venom allergy is confirmed: After skin testing and a serum-specific IgE test by an allergist, consider immunotherapy (venom immunotherapy; VIT)—it is effective in preventing severe reactions upon re-exposure.
  • Patients with a history of severe allergy: Prescription of an epinephrine auto-injector (e.g., EpiPen) and education on its use.
  • If stung in the mouth or throat, or if stung multiple times, visit an emergency room immediately.

Checkpoints Before an Outpatient Visit (Including Example Questions)

• Items to prepare
  • List of currently taken medications (including anticoagulants and antiplatelet agents)
  • Existing allergy history (medications, foods, insects, etc.) and records of reactions to previous bee stings (time, symptoms, and whether treatment was received)
  • Time elapsed since symptom onset and changes in symptoms (local vs. systemic symptoms), and photos of the sting sites and number of stings (if possible)
  • Record of self-administered medication (e.g., epinephrine) and the time it was used
• Information to provide to the healthcare professional during the visit
  • Time and place of the sting, type of bee (if known), and whether the stinger remained in the skin
  • Whether systemic symptoms such as difficulty breathing, hives, or impaired consciousness occurred
• Example questions (patient → consultation room)
  • "What tests should I undergo after being stung by a bee in the past?"
  • "Could the anticoagulant I take affect my treatment or recovery?"

Examples of General Questions to Ask the Doctor

• What are the main side effects of this medication (the prescribed antihistamine, steroid, etc.)?
• What is the prognosis for this reaction? What should I do to reduce the risk if I am stung by a bee in the future?
• If I regularly take medications (e.g., beta-blockers or anticoagulants), could they affect epinephrine use or emergency treatment?
• Do I need allergy testing (specific IgE, skin testing) and bee venom immunotherapy?

Examples of Disease-Specific Questions

• I previously had only a mild local reaction, but this time I experienced difficulty breathing. Do you recommend bee venom immunotherapy?
• There is a high risk of airway swelling when stung in the mouth or throat. If an emergency occurs, what self-treatment (epinephrine) and priority measures should I take before reaching the hospital?

(Note: Mild local reactions often improve with conservative management, but if systemic symptoms such as difficulty breathing, hypotension, or impaired consciousness occur, seek emergency medical care immediately. For people with a history of severe reactions or those who have been stung by multiple bees, consultation with a specialist and, if possible, consideration of bee venom immunotherapy are recommended.)