Bee Sting Reactions & Treatments

Of the more than 1 million species of insects on our planet, bees & their close relatives pose the greatest danger to humans. Bee sting reaction is common.

Question

Two weeks ago my 3 year old Luke, weighing 30 lbs, walked past a fallen hive and was attacked by a swarm of angry bees. He sustained 31 bee stings, 27 on the legs, and others on the head, back, armpit and ear. He experienced no signs of anaphylactic shock, but was miserable from a flaming sensation in the skin for a full day, followed by a week of intense itching. Luke received Benadryl by mouth for the first few days to help the itching, but no other drugs were used. Initially the stings flared up as red bumps, but quickly disappeared within a few hours. Exactly one week later, they reappeared as itchy chicken-pox style bumps, and itched for another week. Today, three weeks later, he has stopped itching, and the red dots are healing. Is there anything else we should be aware of in Luke’s management of future bee stings after this severe exposure? Is there a way to test him in advance for any hypersensitivity he may have developed?
Gale Wilson – MedSeek

Dr. Greene’s Answer:

It’s good to hear from you, Gale, but I’m sorry to hear about Luke’s misadventure! Thirty one stings! I can almost imagine the series of expressions on his face during the onslaught. He must have been terrified. I’m glad Luke has recovered from this as well as he has.

Of the more than one million species of insects on our planet, bees and their close relatives (wasps, yellow jackets, yellow hornets, white-faced hornets, and fire ants) pose the greatest danger to humans. Ironically, they are also perhaps the most beneficial to humans of all insect groups. Dealing with bee stings is relatively simple — unless the child develops an allergy or is stung by many bees.

Bee venom contains at least nine different components that work together to cause reactions in those stung. When a bee injects its venom under the skin, the child may have immediate reactions (those symptoms beginning within 4 hours), delayed reactions (symptoms that don’t appear until more than four hours after the sting), or both (as in Luke’s case). Classifying the reactions is important both for immediate management and for predicting future problems (Allergy Principles and Practice, Mosby 2003; Allergy Asthma Immunol Res. May 2013; 5(3): 129–137).

Bee Sting Classification

Some immediate reactions are classified as local (a two – or three-inch area of swelling, redness and pain that lasts less than 24 hours). Others qualify as large local reactions (those that are larger — often an entire limb — or that last longer, but all symptoms are adjacent to stings). Systemic reactions are allergic responses distant from the sting and include symptoms such as hives, generalized itching, generalized swelling, low blood pressure, difficulty breathing, or anaphylactic shock — a severe reaction involving most or all of these symptoms.

A sting on the forehead with swelling of the eyelids is a large local reaction, while a sting on the foot with swelling of the eyelids is a systemic reaction. Large local reactions are rarely serious and rarely portend future severe allergies. Systemic allergic reactions, though, are present and future warning signs.

A fourth type of immediate reaction is the toxic reaction which can follow multiple stings. This is a direct result of bee venom, and not an allergic reaction. Symptoms can include fever, weakness, nausea, vomiting, and pain. It sounds like Luke’s flaming sensation was probably a toxic reaction from his many stings. Toxic reactions are rarely serious, but do sometimes sensitize the child and herald future allergic reactions.

Delayed Reactions to Bee Sting

Delayed reactions result when the body’s immune system prepares for future stings, but some of the exuberant defense measures inadvertently turn against the body itself. These symptoms begin more than four hours after the initial sting. Delayed reactions include serum sickness (fever, weakness, rash, swelling, and/or intense itching which begin a week after the sting), nephrotic syndrome (inflammation of the kidney), neuritis (inflammation of the nerves), or inflammation of other parts of the body. It sounds like Luke’s second round of itchy bumps was a serum-sickness like reaction.

Predicting Allergic Reactions to Bee Sting

Two types of tests can help predict whether someone will have an allergic reaction to future bee stings. Neither test is perfect, but each can be useful as a supplement to the other. Skin testing is clearly positive in the majority of patients with a convincing history. On the other hand, up to 46% of nonallergic individuals have positive skin tests (Journal of Allergy and Clinical Immunology, 76:803, 1985). Patients with a history of bee-sting related anaphylaxis and a negative skin test should have blood testing as described below and a repeat skin test in 3-6 months (Allergy Principles and Practice, Mosby 2003; Allergy Asthma Immunol Res. May 2013; 5(3): 129–137). Skin testing must be done carefully to prevent systemic reactions in extremely sensitive individuals. It is important to be aware that the degree of positivity of a skin test does not reliably correlate with the severity of the allergic reaction.

A blood test called the RAST test has only about 20% false-negative and false-positive results. Like with skin testing, the level of positivity of the test gives no information about the degree of allergy present.

Neither form of testing is indicated following local or large local reactions alone.

Bee Sting Treatment

Treatment of allergies includes preventing stings, carrying epinephrine (that should be injected following a sting whenever there are any systemic symptoms such as dizziness, swelling of the lips or tongue, or difficulty breathing), corticosteroids, antihistamines, and/or possibly allergy shots. Allergy shots can often desensitize people to bee stings. They are usually reserved for those who have had both a systemic allergic reaction and either positive skin or positive RAST tests. (If the tests were both negative, one wouldn’t know which type of bee allergy shots to give).

Even without treatment, most children outgrow their allergies to bee stings. In one study of 174 untreated children aged 3 to 16 with previous systemic allergic reactions following stings, there were 196 stings over a subsequent four-year period. Only 18 (9.2%) of these subsequent stings produced systemic symptoms — none more severe than the original episode. Symptoms of anaphylactic shock are the greatest predictor of future severe reactions (New England Journal of Medicine, 323:1601, 1990).

More than one million people in the United States are allergic to bee stings. Thankfully, only about 40 deaths occur in the U.S. each year — mostly adults. Although I would recommend, Gale, that you consult an allergist, Luke has a great chance of outgrowing (without treatment) any allergy he may have developed from this unpleasant incident (yeeouch!).

Medical Review on: January 31, 2015
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Dr. Greene is a practicing physician, author, national and international TEDx speaker, and global health advocate. He is a graduate of Princeton University and University of California San Francisco.
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33 Comments
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Recent Comments

Hi Dr Greene
My husband who has had about 1 or 2 bee stings in his life (he is 56 now) with no real side effects other than swelling for a short time, was stung 8 months ago by a swarm of African Bees (We live in South Africa). He must have had in the region of 25 stings mostly to the Upper body and face – scalp, eyelids and ears and lips. He quickly went into anaphylactic shock and collapsed on the bed. We were on our farm and nt able to get to a clinic as I could not lift him, so I had a product called Allergex, which I managed to get him to take. A friend also managed to bring him some bee sting pills from a pharmacist which he took (he had almost recovered by the time the friend arrived). He recovered in a few days with no seeming side effects.

A couple of months later, he broke out in a severe hives rash, which went away after a few hours and have not returned. 8 months later, he is now struggling with a tightness and wheezing in his chest and feels tired a lot and his voice sounds “restrained” for better want of a word. He is very physically active usually and is never ill – even with colds or flu.

I am not sure if the wheezing could be caused by a long-term Bee sting reaction too. It feels almost like an allergic reaction than something else.

Any insight into this will be very helpful
Many thanks in advance. Steph Kay

My hand is swelled after 1 week of honey bee bit… what should I do ?

And 51 year old female I was stung 27 to 31 x by the yellow jackets much like Luke I had my initial round of reaction followed by a week later the swelling has returned with a itching of great degree wondering if I should have a rast test

I was mowing on a riding mower and was stung by a black and white flying thing. It really burned bad and I put alcohol on it. It was about 4 inches by 3 inches. It had been a week and it is sort of triangle shaped and not as big but it really itches still. I have put cortisone cream on it and chigger/insect bite cream in it. What should I do? Thank you 😊

Hi Vanna. Large local reactions to insect stings usually get bigger over a day or two, peak by about 48 hours, and then gradually get better over 5 to 10 days. Still itching after a week is no fun – but not unusual. Cortisone cream and other anti-itch creams can help. Often adding an oral antihistamine like cetirizine (Zyrtec) daily will help more. Some people also get temporary relief from cool compresses and/or a lukewarm oatmeal (or Aveeno) bath. Best – DrGreene

Hi…ten days ago l was stung or bitten by something on my hand between two knuckles. Walked out my door to the car and noticed pain, bump and numbness starting with my fingers and went up through palm and halfway to the elbow. Bump still there and not painful to touch but still very painful when making a fist or streching hand out flat. Any thoughts would greatly be appreciated.

I am allergic to bees,must carry epie pen! I was stung in the ankle area about 8 years ago,( yellow jackets),since than if I get stung,arm,neck,etc,my ankle area starts to itch like crazy.
is this normal,or is there something I should havr checked out.Thank you for any input.

Hi I was stung from a bee 3 weeks ago first it went red itchy hot and swollen then the red spot started to speed to an oval size single bread bun then it went purple now 3 weeks later it’s still slightly ther a gray purple colour and hurts to push on , am I allergic ??

I got stunk under my arm, pulled stinger out. It swelled, turned red and got very itchy. I have been getting severe headaches and terrible cramps/pains in my legs. Could this be results of the sting?

Maureen,

Dr. Greene says, “A fourth type of immediate reaction is the toxic reaction which can follow multiple stings. This is a direct result of bee venom, and not an allergic reaction. Symptoms can include fever, weakness, nausea, vomiting, and pain. It sounds like Luke’s flaming sensation was probably a toxic reaction from his many stings. Toxic reactions are rarely serious, but do sometimes sensitize the child and herald future allergic reactions.”

It sounds like you only had one sting, but it may be a toxic reaction. It would be worth a conversation with your doctor both for these symptoms and possible future stings.

Best,
@MsGreene
Co-founder & Executive Producer DrGreene.com, Mom
Note: I answer a lot of questions on DrGreene.com, I am the co-founder of DrGreene.com, Dr. Greene’s business partner and wife, but I am a not doctor. Please keep that in mind when reading my comments and replies.

Dr Greene
I have some swelling at the back of my ear after multiple bee sting three days ago,it started with fever,I haven’t consulted any doctor since then,I have started to diarrhea,it’s itchy, please help

Rahab,

Dr. Greene states to another reader, “Systemic reactions such as hives, redness, or swelling elsewhere on the body, vomiting, dizziness, hoarseness, thickened speech, or difficulty breathing, should receive prompt medical care from a physician.” Do you have any of these symptoms? Fever and diarrhea aren’t on his list. Perhaps these aren’t related to the bee sting, but if they are, sounds like you should see a doctor.

@MsGreene
Co-founder & Executive Producer DrGreene.com, Mom
Note: Not Dr. Greene, not a doctor. Keep that in mind when reading my comments and replies.

hi i had a bee sting from may that is still on my toe and its oct.
what do i do because it still hurts every time i walk or press pressure on it like when im driving.

I got a bee sting on my face it is swollen. I tried honey , ice Vicks, toothpaste it is still the sam

Hodo,

I would see a podiatrist.

Best,
@MsGreene

I would love to hear the answers to the people who have a flare-up a week later. I was stung multiple times on my temple and once on my back. I had to go to urgent care and get epinephrine and Benadryl and a steroid shot because I swelled up immediately on my face, my eyelids, my tongue, and I went numb from my elbow is down and my knees down. The swelling went down. I took Benadryl for a couple days and 4 days later it has started to come back. Now it is 6 days later and I’m gradually swelling on my face and it is intensely itching. It has swelled to Mayeye and is going down towards my jaw and into my cheek. Also the sting on my back is getting larger and swelling and itching. They’re both painful.

Kelly,

I am not a doctor, but I did have an allergic reaction (not to bees, though) that had a bounce back. The doctors took it very seriously. I wound up with more Benadryl and observation, but I was very close to an ambulance ride to the ER.

Have you gone yet?

@MsGreene

Hi
My son is 4 year old . He got bee sting under lower eye lid 7 days ago in his school . After 7 day he again have red rash on same spot . What should I do ?
Thank
Mandy

This exact thing is going on with my 3 year old son. He got stung on the ear a week ago and had some swelling, which I expected, but it went away after some benadryl and a half day. Then, in the middle of the night, he wakes up with a swollen, red, itchy, hot ear. It is very strange. I’m treating with ice, ibuprofen for pain and swelling, and benadryl. I will call pediatrician if it doesn’t go back down after 24 hours.

Hi Dr. Greene,
I was looking for an answer about my current bee sting (very rough and red skin 4 days after sting, onandoff itchy and painful). I came across your definition of Nephrotic Syndrome. My cousin suffers from Nephrotic Syndrome that was triggered by a bee. The definition you have of Nephrotic syndrome is inaccurate and should be corrected. It seems to have been confused with Nephritis, which I do not know much about. Nephrotic Syndrome can cause swelling, as in edema, due to the kidney not functioning properly. This is a very serous condition which needs medical treatment. If edema of the whole body occurs following a sting medical treatment is needed. It took a full month of gradual swelling before my cousin was properly diagnosed. By that time she had gained an additional 40 percent of her body weight, she was only 5 yrs old and so swollen she could not walk upstairs. This is a chronic illness with symptoms that can last into late teens and beyond. Thank you for looking into a correction.

Hi Jess,

Where do you see “definition you have of Nephrotic syndrome”? Would love to help, but I don’t see what you’re referring to.

Best,
@MsGreene
Co-founder & Executive Producer, DrGreene.com

Dr.Greene
I heard my grandson screaming in are woods and found that he had stepped on some tiny yellow striped stripped bees. I thought they were yellow jackets. I got the insects out of his shoes they were in a small rotten tree limb. He was not affected much but I continue to have terrible itching and swelling, deep redness that starts below the elbow and goes up almost to the underarm. This has been going on for 7 days. I have not any respiratory involvement nor do I feel bad. Do I need to see a doctor since it has last this long??
Thanks……..Glenna

Might b poison ivy?

After a week of intense itching, sounds like you should see your doctor. I don’t think it’s urgent. You can likely wait until Monday when the doctor’s office is open.

Hope that helps,
@MsGreene
Co-founder and Executive Producer, DrGreene.com

HI I’m allergic to hornets. I’m on shot,started last Aug. I got a bee shot last of Jan. Now they say I didn’t recieved a shot today, was in Florida and no one would give my shot so didn’t get it. Now they want me to get a shot weekly. Will that be to much? Will I get a reaction by too much bee shot? Start next week, for few weeks.

Hi, my 6yo nephew was stung by a bee on his neck and had no sign besides redness around the sting and redness on his chest where the stinger fell. 24 hours later his neck and face started swelling. He got a rash and hives where the stinger had fell and all over his neck and face. He complained of not being able to swallow. He was taken to the er bc of the time. The dr said it was a severe allergic reaction to the sting. He was prescribed pretenzone and Benadryl. It is almost a week later and he still is breaking out in hives and a lot of swelling. He went to an allergist and was told that you don’t have allergic reactions or any reaction to sting bites after 6 hours of being stung. He was prescribed an epipin at the er and they were very concerned. I’m not sure what to trust. Any recommendations would be appreciated.

Hello Dr Alan, I got stung by a bee 1 week ago on the inside of my (R) ankle . I had a sock on when I got me and may have stuck me twice and it was a yellow jacket. It responded to conservative treatment but a week later it is still very itchy, puffy on both sides of ankle. Ice packs help and I feel fine but let me know what you recommend for this.

Thanks, michael

Again, yellow jackets are not bees. These are two different things.

Hi I was stung 8-10 times two weeks ago. I was weed trimming and hit a ground nest. Mostly my ankles one on my calf and one on my forearm. The stings on my forearm and calf turned red and started itching a couple days ago. Just wondering what I can put on or do to make the itch go away and the redness?

Those aren’t bees. Those are wasps. Completely different. Bees do not live in the ground.

Hello Dr. Alan,
Please I want to ask you if you know, my daughter have nephrotic syndrome, and I want to know, treatment with bee venom if can help her to recovery her immune system. Also, if that is safe for her.

Thank you in advance.