Bee Sting Reactions and Allergies - An Overview

Everything You Need to Know About Bee Stings and Allergies

Woman preparing epipen for bee sting
Peter Dazeley / Getty Images

How can you know if you are allergic to bee stings and what types of reactions may occur? What do you need to know about treatment for stings, and when could these be an emergency? How may allergy shots help to "cure" the allergy for some people? Let's talk about everything you need to know about bee sting allergy.

Overview

Allergic reactions to flying stinging insects (honeybees, hornets, wasps, yellow jackets, and fire ants) are relatively common.

Most people who are stung by these insects will develop a reaction at the site of the sting that will cause pain, swelling, redness, and itching. A smaller percentage of people—about 10 to 15 percent—also will experience larger areas of swelling, and the swelling can last up to a week. Less commonly, people may experience a full-blown serious allergic reaction called anaphylaxis. About 1 in 200 children and up to three percent of adults will experience anaphylaxis after a stinging insect bite.

In addition, about 40 people in the United States die every year from a venom allergy, although there are likely other deaths from insect stings that are attributed to other causes, and therefore this number is probably a low estimate. Most of these deaths occur among people without a known history of venom allergy.

Risk Factors

What we just noted—that most deaths from bee sting allergies occur in those who were unaware of their allergy—can be terrifying.

Keep in mind that even though this is tragic, it is a small number relative to many other hazards in our midst. One allergist reminds his patients that they are much more likely to die in a motor vehicle on their way to the park than from a bee sting while playing at the park. While a severe allergic reaction to bees may occur in anyone, those who have a history of other allergic diseases, such as allergic rhinitis (hayfever) and asthma are at a greater risk.

Before going into depth on bee sting allergy, it's important to review the signs and symptoms of anaphylaxis. If you've been stung and have any of these symptoms, stop reading and seek immediate medical attention.

Signs and Symptoms

When someone has a whole-body (systemic, or anaphylactic) allergic reaction to insect stings, she may experience any or all of the following symptoms, usually within a matter of minutes to a few hours:

  • Itching all over
  • Hives or swelling that spreads from the site of the sting
  • Flushing
  • A runny nose, sneezing or postnasal drip
  • Itchy/watery eyes
  • Swelling of the lips, tongue or throat
  • Shortness of breath, wheezing or coughing
  • Stomach cramping, nausea, vomiting or diarrhea
  • Lightheadedness, fast heart rate, low blood pressure or passing out
  • A sense of panic or sense of impending doom
  • A metallic taste in the mouth

Insects That Cause Venom Allergies

There are several different stinging flying insects which may cause venom allergies. While it may be helpful later on, identifying the precise insect which led to an allergy is much less important than seeking rapid medical attention. When considering allergy shots this information can be helpful, as different therapies are used for different insects.

That said, allergy tests are used along with a history to help determine the precise culprit. Let's take a look at some of these insects:

Yellow jackets are wasp-like insects that live in mounds built into the ground, They tend to be aggressive insects, and are a common nuisance at picnics and around trash cans where food and sugary drinks are abundant. Stings on the lip or inside the mouth or throat can occur when a drink is taken from an open can of soda that a yellow jacket had crawled into. Occasionally, stings from yellow jackets can result in a skin infection because these insects can carry bacteria.

Hornets, including yellow and white-faced hornets, build paper-mâché type nests in trees and shrubs. These insects may be very aggressive, and sting people because of a mild disruption, such as someone nearby mowing a lawn or trimming a tree.

Wasps build honeycomb nests under the eaves of a house, or in a tree, shrub or under patio furniture. They tend to be less aggressive than yellow jackets and hornets, and mostly feed on insects and flower nectar.

Honeybees commonly nest in tree hollows, logs or inside buildings. Away from their hive, honeybees tend to be non-aggressive but can be more aggressive when their hive is threatened or disturbed. Stings from honeybees are common when a person walks barefoot on a clover-filled lawn. They are the only stinging insect to routinely leave a stinger in the victim’s skin, although other stinging insects occasionally do so as well. While there has been much written about removing stingers, the best method is whatever is quickest. The longer the stinger is in the skin (up to 20 seconds anyway) the more venom which may be injected.

Africanized (killer) honeybees are far more aggressive than domestic honeybees, which were created by cross-breeding African honeybees with domestic honeybees in South America for the purpose of greater honey production. Their venom is essentially the same as domestic honeybees—meaning that a person allergic to a typical honeybee will also be allergic to Africanized honeybees. They tend to sting in large groups, sometimes by the hundreds.

Bumblebees rarely sting people because they are non-aggressive and typically mild-mannered. They will sting if provoked or if their nest is disturbed, but they are so loud and slow, a person usually has plenty of time and warning to escape. They nest on the ground or in piles of grass clippings or wood and feed on insects and flower nectar.

Learn more about how to figure out what insect stung you.

Prevention

Put simply, the best way to prevent an allergic reaction is to avoid being stung. Here are a few tips:

  • Hire a trained exterminator to treat any known nests in the immediate area; periodic surveillance for further infestation should be performed.
  • Avoid looking or smelling like a flower. Do not wear brightly colored clothing or flowery prints, or perfumes or other scents that will attract insects.
  • Always wear shoes when walking outside, particularly on grass.
  • Wear pants, long-sleeved shirts, gloves, close-toed shoes, and socks when working outdoors.
  • Use caution when working around bushes, shrubs, trees and trash cans.
  • Always check food and drinks (especially open cans of soda or drinks with straws) before consuming, especially at pools and picnics, where yellow jackets are known to be present.
  • Keep an insecticide, approved for the use on stinging insects, available should treatment of a nest be necessary.

Testing

Testing is performed using allergy skin testing or by performing a RAST. Skin testing is still the preferred method and the procedure is similar to testing for pollen or pet allergies. However, it may be necessary to use increasing concentrations of venom extracts to make a diagnosis. Allergists usually test for all stinging insects (bees, wasps, etc.) since studies have shown that people usually can't identify which type of insect stung them.

A person stung by only one insect may show positive allergy tests to more than one type of insect. In this situation, treatment using venom from all of the species is usually given.

Who Should be Tested

It's not always a clear-cut case who should be tested for a bee allergy, but in general:

Testing is not needed If a person has never been stung by an insect, or never had any symptoms (other than pain at the site of the sting) as a result of a sting, there is no need to perform any venom allergy testing.

Or, if a child under 16 years of age has only skin symptoms (such as hives and swelling) after a sting. This is because anaphylaxis will only occur in up to 10 percent of future insect stings.

Or, if a child or adult has a large local reaction, where swelling occurs at the site of the sting only, is not usually a reason to perform venom testing or to administer venom allergy shots. This is because the chance of developing anaphylaxis with future stings is only about 5 to 10 percent for both children and adults. (A few studies show that these reactions can be decreased with the use of venom immunotherapy, and this may be required in situations where stings are frequent and the swelling disrupts a person’s quality of life or ability to work.)

Testing is needed: If a person of any age has symptoms of anaphylaxis (see page 1) after being stung. That's because the person has about a 60 to 70 percent chance that future insect stings will cause a similar reaction. The chance of a reaction to a future sting will decrease over time but still remains at about 20 percent many years after the last sting.

Also, if there is a particular parental concern or the child is at high risk for frequent stings, venom testing and treatment is a reasonable option. People older than 16 with these same concerns should have venom testing and treatment, given a higher risk of anaphylaxis with future stings.

Of note: If a person is found to have a positive allergy test to venom, yet has had no symptoms with stings, the chance of developing anaphylaxis with future stings is approximately 17 percent.

Treatment

The treatment of venom allergy involves the management of an acute reaction, as well as the prevention of future reactions.

Immediate treatment of acute reactions. Epinephrine is the treatment of choice for anaphylaxis. People with venom allergy are encouraged to carry a self-injectable form of epinephrine, such as an Epi-Pen or Twin-Ject device. If this medication is required, immediate medical attention is also needed, and the person should call 911 or go to the emergency room.

If itching or hives are the only symptom, an oral antihistamine may be all that is required although seeking emergency medical attention is still advised. If symptoms worsen or swelling of the skin affects the ability to breathe, then epinephrine will be required.

If a stinger remains in the skin, such as with a honeybee sting, it should be removed quickly so that more venom is not injected into the sting. Do not squeeze the stinger or the site of the skin—instead, pull the stinger out with tweezers or scrape the stinger out with the edge of a credit card. Put ice or a cold compress at the sting site to reduce local swelling.

Treatment of future reactions. To prevent reactions to future insect stings, avoid being around stinging insects. If a person has experienced anaphylaxis, or whole-body skin symptoms (hives, itching, flushing, swelling away from the sting site) in those 16 years and older, then venom and testing are required.

Immunotherapy, or allergy shots, using purified venom from the type of insect to which a person is allergic, can cure venom allergy. Allergy shots using pure venom is given in much the same way as allergy shots for pollen allergy. After a person is receiving appropriate doses of venom allergy shots, the chance of a reaction with future stings is reduced to less than 5 percent. After a series of venom allergy shots for at least 3 to 5 years, most people can stop the shots without a significant increase in the chance of allergic reactions.

However, some people with severe, life-threatening reactions from insect stings, or those who have had anaphylaxis from the venom allergy shots themselves, may require life-long venom allergy shots. This is because a person’s chances of a reaction to future stings may slowly increase to as high as 20 percent many years after venom allergy shots are stopped. This topic is an evolving area of venom allergy research and requires careful discussion between a person and their allergist.

For those with severe allergies who must—due to occupation or hobby—be in a situation in which stings could easily occur, the option of rush immunotherapy should be considered. Accelerated immunotherapy such as rush, though it carries an increased risk of reactions, can result in control of venom allergies much more rapidly that "regular" allergy shots.

After Allergy Shots for Bee Allergy

Some allergists perform venom allergy testing, either with skin testing or RAST, after venom immunotherapy has been given for a period of time. Venom immunotherapy can be stopped in the majority of people whose allergy test turns negative, although the test does not always turn negative, even in people who have received venom allergy shots for years.

Recent studies suggest that many children who begin allergy shots for bee stings do not complete their therapy. Keep in mind that allergy shots can cure a bee sting allergy and reduce the likelihood of a life-threatening allergic reaction in the future, but the full course of treatment needs to be completed.

The Bottom Line

All people with a history of allergic reactions to insect stings, including children with skin-only reactions and even those with large local reactions, should consider having some form of medical alert, whether a bracelet, wallet card, or scroll I.D. identifying their medical condition, as well as having an injectable form of epinephrine available for immediate use. This EpiPen should be carried with you wherever you go. The TSA generally allows you to carry your EpiPen with you in your carry-on if you fly, but check ahead to make sure.

Bee stings are common, and allergic reactions can result in severe reactions or even death. That said, recognizing the symptoms of anaphylaxis and calling for immediate attention can decrease the risk of these life-threatening complications.

Most people with mild reactions will not need shots, yet allergy shots offer the option of a cure for those with serious allergies.

It's important to note one last time that most fatalities due to bee sting allergy occur in those who do not have a known allergy. Everyone should be familiar with the signs and symptoms of anaphylaxis and how to contact emergency help if needed.

Sources

Continue Reading