Stung by a Bee

If I don't see a stinger is it under the skin?

Apis mellifera (honey bee) - the stinger of a black honey bee, torn from the bee's body
A venom sac still stuck to a barbed honey bee stinger. Paul Starosta / Getty Images

A reader once told me a story of being stung by a bee and not seeing the stinger when he looked. He wanted to know: does that mean the stinger is still under the skin?

The answer is no. There's no stinger under the skin. If the bee left a stinger behind, you can see it.

Only a few species of bees have barbed stingers. A few yellow jackets also have small barbs on their stingers, but they're not big enough to catch in the skin.

Different species of bees and wasps are going to have differently sized stingers. The bees with sharply barbed stingers—that leave a venom sac and stinger behind—are only female worker honeybees. Those are the bees that we think of when we consider how to take the stinger out.

How to Remove a Bee Stinger

There's some controversy surrounding the best method for removing a bee stinger. Some say it needs to be scraped out to avoid squeezing more venom into the skin. Others say just grab and pull. I say you probably don't care about the controversy so much and just want to know how to get the friggin' bee stinger out of your arm!

The best way to remove a bee stinger is to pull it out; brush it off; scrape it off. Basically, remove it in whatever way you can. It doesn't matter how you remove a bee stinger, what matters is how quickly you remove it.

There's no evidence that one way of removing a bee stinger is better than another.

I could only find one published study that looked at the issue. It compared the difference in reactions between bee stingers that were removed by pulling and bee stingers that were scraped off. It's not a great study because it was a very small number of stings being compared, but I think it made the point.

In that study, the only thing that mattered was time. Pinching the stinger and pulling it out didn't cause more of a reaction than scraping it off with a credit card. What did cause a bigger reaction was leaving the stinger in the skin longer.

The moral of the story is to do what animals do: Get the stinger out! When animals get stung, they don't reach into their wallets for their library card to scrape out the stinger. They bite it off or rub up against a tree or scratch with their paws. Animals instinctively know that if it hurts it needs to go, the sooner the better.

When a Bee Sting is Dangerous

Unfortunately for most people who are allergic to bee stings, they only found out by getting stung. If you're stung by a bee and the bump (called a weal) swells up large and turns red, watch for redness and swelling spreading out away from the weal. Spreading, swelling, or fever (meaning it feels hot) can be signs of infection or allergy.

Be aware of any itching or burning on skin that's not touching the weal, or of trouble breathing, difficulty swallowing, scratchy throat, dizziness, or weakness after the sting. Any of these signs and symptoms could indicate anaphylaxis (a severe allergic reaction).

Anaphylaxis is a life-threatening medical emergency that requires immediate medical treatment.

Patients who know they are allergic to bee stings might be carrying epinephrine. Epinephrine is a form of adrenaline and it is used to treat severe anaphylaxis. If the patient is carrying an epinephrine auto-injector, help the patient use the auto-injector as soon as they or you begin to recognize the symptoms of anaphylaxis.

People who are allergic to bee stings will most likely be allergic to all bee species. Treat all bee stings the same: You don't have to worry about removing a stinger if you don't see one.

The way that stingers and venom sacs are shaped leads to the fact that it is really hard to get a stinger under the skin. 

In the unlikely case part or all of a stinger has become lodged underneath the skin, it will probably work its way out over a few days much like a splinter. If the swelling doesn't go down after a couple of days, you may need to see a doctor to rule out or confirm a possible infection.

If the patient is allergic to bee stings, make sure the patient goes to the doctor right away if you or the patient think there is a stinger still under the skin. It's the exception to the rule.

Sources:

Abtahi, S., Razmjoo, Abtahi, Roomizadeh, & Mohammadi. (2011). Management of corneal bee sting. Clinical Ophthalmology, 1697. doi:10.2147/opth.s26919

Cooper RA, Goldberg PL. Should x-rays be ordered to find a bee's stinger? Pediatr Emerg Care. 1988 Sep;4(3):205-6.

Farrar, C.L. "The Life of the Honey Bee." American Bee Journal. Vol. 108, No.2, 1968.

Visscher PK, Vetter RS, Camazine S. "Removing bee stings." Lancet. 1996 Aug 3;348(9023):301-2.

Continue Reading