Bites and Stings: Animals


Bites and Stings: Animals | Johns Hopkins Medicine

When Brigham Dimick was 13, he nearly died after stepping on a nest of yellow jackets hidden in a rotted railroad trestle in Union Terrace Park.

The shiny black and yellow wasps stung him, triggering an allergic reaction throughout his body. He felt his chest tighten and had trouble breathing, but managed to ride his bicycle home before collapsing in the driveway.

His mother, who arrived at the same time, saw Brigham turning blue, put him in the back of the car and sped off to Allentown Hospital's emergency room. Because the Allentown Fair was in progress that week, she drove through barricades on the street to reach her destination.

“We made it with only seconds to spare,” Elsa Dimick said recently, recalling her son's close call. “After an hour, I was told there was a chance they could save him.”

A quick injection of epinephrine (adrenaline) did the trick, counteracting the life-threatening effects of the venom.

Ironically, 11 years later, Brigham's brother also came close to dying from an insect sting.

Timothy was 26 and lived on a secluded mountain in California when a single sting sent his central nervous system into shock.

“A call from a garbled voice said, 'Mom, I'm dying,' ” Mrs. Dimick said.

If it hadn't been that Brigham forgot his bee sting kit at Timothy's house during a prior visit and that a friend wandered into the house at the time, Timothy would not have made it, according to his father, Dean, an endocrinologist and vice president of academic affairs for the HealthEast hospitals.

“When I talked with (Timothy) I said, 'Don't worry, just inject about half of the epinephrine into your muscle,' ” Dimick recalled. “He said, 'I can't, I'm too weak.'

“But just then a girl walked in, picked up the telephone and was able to give him the injection and resuscitate him.”

What happened to the Dimick boys was extraordinary in that the two members of the same family survived such severe reactions to their close encounters with the insect world.

No one knows for sure what percentage of the population will sustain life- threatening “systemic” reactions theirs, but authorities believe that most people suffer only local skin reactions, the type that cause a red, itchy swelling at the site of the sting or bite.

Estimates of Americans with a history of severe reactions have been put at 1 percent of children and as high as 4 percent of adults, according to Dr. Chester T. Stafford, chairman of the insect hypersensitivity committee of the American College of Allergy & Immunology.

Although new studies at Johns Hopkins University suggest the rate may be as high as 15 percent, the people in the study showed positive reactions to skin tests, but had not had a history of systemic reactions.

People who suffer local skin reactions generally do not go on to develop life-threatening allergies, Allentown allergy and asthma specialist Dr. Harold Kreithen added.

Un hay fever, allergic reactions to the venom of bees, hornets and wasps – a group of flying insects known as hymenopterans – are not known to be inherited, Stafford said.

Fortunately, people prone to systemic reactions can take precautions against anaphylactic shock and death.

People don't die after their first sting, Kreithen said. Typically, the first sting produces a mild reaction hives appearing all over the body.

But one sting sets a person up for a more severe reaction, decreased blood pressure, shock, difficulty breathing and swallowing.

Stings that cause a quick death tend to be the third or fourth, according to Kreithen.

Most troubling to Stafford and other researchers, however, is the fact that almost half of all fatal reactions occurred after the first known sting. People may have been stung before and had a systemic reaction, but did not know it.

Still, the risk of death is relatively small. Although a 58-year-old Breinigsville R.2 man died from a bee sting at his home in September 1987, no one from Lehigh or Northampton counties has died from bee stings in 1988 or so far this year, according to the coroners. In the United States, approximately 40 deaths a year are attributed to the venom from bees, wasps or hornets.

People who have had a systemic reaction, hives, to an insect sting, can find out if they are allergic and to which insects by undergoing a skin test.

The test takes 2-3 hours, costs $150 and “is not particularly painful,” Kreithen said. During the test, a patient's skin is pricked and a weak solution of venom from each of five flying insects is applied.

Nurses watch for a swelling or hive. If none appear, the concentration of venom is increased slightly. The process is repeated for six stages.

After the initial prick test, the screening is done intradermally, Stafford said, explaining that a small amount of venom extract is injected into the upper layers of skin on the arm. A maximum strength of 1 microgram per milliliter is inserted this way and if there is no reaction, the test is considered negative.

If an allergy is diagnosed, the patient can then undergo immunotherapy – injections of venom over time until the body builds up enough antibodies to protect it from future stings.

A fairly expensive process at $500 to $700 the first year, immunotherapy involves an injection each week for eight weeks, another during the 10th week and 13th week, then a shot monthly for maintenance.

While many patients are maintained for years on a once-a-month immunotherapy schedule, Kreithen stretches the shots out to every six weeks after the first year and every eight weeks after the second year.

Until recently, allergy specialists believed that the injections had to continue indefinitely to protect the patients. But new studies indicate Immunotherapy remains effective five years after patients stop at five years of treatment.

Kreithen currently has 50-60 patients on immunotherapy, some of whom had been taking injections for nine years. He recently began weaning those with more than five years invested in the therapy.

Brigham learned he was allergic to all the bees, wasps and hornets for which he was tested and has been receiving shots every six weeks for years. The desensitization appears to have worked, however, because he has been stung since without more than a mild reaction.

The number of people allergic to bee and wasp stings may be far higher than previously thought, according to researchers at Johns Hopkins University School of Medicine.

In laboratory tests, David B.K. Golden and colleagues found that 15 percent of subjects with no known risk of reaction to bee and wasp stings had positive skin test results (adverse reactions) to bee and yellow jacket venom.

People prone to systemic reactions also are advised to carry prescribed kits of antihistamine and adrenaline so they can administer the preloaded medication into their thigh muscle immediately after being stung.

The handy kits, with brand names “Ana-Kit” and “EpiPen,” cost about $20 and are recommended even for people on immunotherapy, Kreithen said.

Proven 95 percent effective, the kits should not be relied upon as the only treatment, according to Stafford.

“There is sufficient medication in the shots to control the condition until the patient arrives at a medical center,” he said.

“But a better approach involves three measures: education to reduce the lihood of being stung, the adrenaline kits and venom immunotherapy. We recommend all three, not one versus another.”

Mrs. Dimick has not had a history of allergic reactions or a positive skin test for allergies to venom, but carries a bee sting kit with her religiously, in her car, handbag and when biking.

“I don't take it lightly when someone gets stung,” she said. “the sight of my son not breathing is something I'll never forget.”

Bee stings occur most often from the end of August to the first frost, according to Kreithen.

They are especially prevalent at large outdoor fairs and carnivals, where lots of food, garbage and animals attract the insects.

“The perils of the patio can happen any time during warmer months, but the highest incidence of stings and bites occur in late summer,” Stafford said.

About fairs, he added, “We recommend people not walk with open soda cans or congregate near open garbage containers. The containers should be closed.”

When it comes to insect allergies, stinging insects bees, hornets and wasps pose a greater problem than those that bite, mosquitoes, deer flies and mayflies, authorities said.

While biting insects can be a nuisance, Kreithen said they are not known to cause serious allergic reactions their stinging cousins.

“Honey bees kill more people each year than rattlesnakes,” Stafford added, citing a 1959 study of 460 deaths from venomous animals by Dr. Henry M. Parish.

Most people who are stung get stung by honey bees, yellow jackets and other wasps.

Yellow jackets, which are wasps, are the most aggressive. They do not need to be provoked to attack and often sting repeatedly. Honey bees, on the other hand, are usually stepped on before they sting and then sting only once.

There are other bugs that commonly attack humans. The following is a list of prime offenders and interesting anecdotes supplied by Dr. Alan Schragger, an Allentown dermatologist:

– Lice – There are head, body and pubic lice, but according to Schragger the head lice will mingle with the pubic lice but not the body lice. Head lice are easy to see, he said, because there are lots of little eggs.

Pubic lice look little crabs, with crab- claws. They use this claw to swing from hair to hair, “sort of a Tarzan of the pubic hair.

” Lice can be a problem all year long and can be effectively removed with one of a number of over-the-counter or prescription shampoos.

– Scabies – These microscopic organisms are hard to find and tend to hide along the folds of skin, between fingers and toes and on the buttocks. “They can produce weird looking bumps on the penis, which scares a lot of people,” Schragger said.

The main problem with scabies is it usually takes about three months after a person is bitten by scabies for him to become allergic and start to itch. By that time, Schragger said the whole family could be infected since the scabies multiply rapidly.

A dose of Qwell or Eurex from head to toes usually rids people of the problem.

– Black Widow Spiders – “We don't see many of these bites any more,” Schragger said, adding that the poisonous spiders used to to hang out in outhouses. Of greater concern, he said, are bites from the brown recluse spider, whose venom can cause the surrounding skin and muscle to die if treatment is not administered quickly.

– Bird mites – These are little mites that bite people. Although they generally prefer birds, mites had caused some local children discomfort in recent years when birds built a nest near their window and an air conditioner blew the critters into the children's bedroom.


Fatal Infection after a Bee Sting

Bites and Stings: Animals | Johns Hopkins Medicine

Life-threatening or even fatal infections can rarely develop after bee stings.

Deaths resulting from bee stings are uncommon [1, 2]. When they do occur, the deaths are usually due to anaphylactic shock, suffocation after stings in the airways, or preexisting diseases, such as atherosclerotic heart disease [2].

Deaths due to massive envenomation have also been noted, especially among individuals stung by so-called Africanized honeybees, which attack in great numbers [3]. There are rare reports of local [4] and disseminated [5–7] infections after bee stings, none of which proved fatal.

We report a case of fatal disseminated infection after a bee sting; to our knowledge, it is the first such case ever reported in the English-language medical literature.

The left hand of a 71-year-old man was stung by a bee. The man had undergone aortic valve replacement 12 years before presentation, and he had undergone placement of a cardiac pacemaker 2 years before presentation. Less than 2 weeks after the bee sting, intense pain in the left hand, malaise, and chills developed.

Within 24 h of the onset of these symptoms, the patient developed severe pain in the right foot, which led to an inability to bear weight on the right leg. The patient became increasingly lethargic, was moaning, and eventually fell bed, which prompted his admission to a hospital. At the time of admission, his temperature was 41.

4°C, and his systolic blood pressure was 70 mm Hg.

The patient was transferred to our institution, The Johns Hopkins Hospital, Baltimore, for evaluation of presumptive prosthetic valve endocarditis. Our initial evaluation revealed marked edema of the left hand and right foot, with purpura and break-down of the skin. The patient was treated with broad-spectrum antibiotics for suspected sepsis.

An echocardiogram showed poor left ventricular function with global hypokinesis, but no evidence of aortic valve vegetations. The patient underwent intubation.

Meanwhile, at the first hospital where the patient was treated, the results of culture of blood samples became positive for group A β-hemolytic Streptococcus species (Streptococcus pyogenes). The patient became progressively hypotensive, ventilator dependent, and deeply comatose. His left arm and right leg were described as “necrotic.

” In view of the grim prognosis, the attending physicians and the patient's family decided to institute a “do not resuscitate” order. The patient died 4 days after the onset of symptoms.

An autopsy was performed (excluding examination of the brain). There were multiple bullous lesions of the skin that involved the left hand and distal forearm, right distal lower extremity, scrotum, and left earlobe; these lesions were identified as toxic epidermal necrolysis associated with bacterial exotoxin.

There was erythema and induration of the entire left upper extremity and the distal right lower extremity to the level of the midcalf. Histological examination of the lower extremity lesions revealed acute inflammation and frequent gram-positive cocci within the subcutaneous soft tissue.

The heart had several microscopic abscesses within the right ventricular free wall, in the region of the pacemaker wire anchoring, and these contained numerous gram-positive cocci (figure 1). There was no evidence of aortic valve vegetations. The left ventricular myocardium showed patchy replacement fibrosis but no distinct infarcts.

There was no significant narrowing or thrombosis of the coronary arteries. In addition, there was histological evidence of disseminated intravascular coagulation and ischemia of multiple organs and tissues.

Open in new tabDownload slide

Microabscess in the right ventricular myocardium of a patient in whom group A β-hemolytic Streptococcus infection developed after he was stung by a bee.

Left, Hematoxylin and eosin stain showing focal cardiomyocyte necrosis, hemorrhage, and numerous polymorphonuclear leukocytes (original magnification, ×100).

Right, Gram-Weigert stain showing numerous gram-positive cocci surrounding cardiomyocytes (original magnification, ×630).

Infections resulting from bee stings are rare and have not been studied as a medical phenomenon. Klug et al. reported a case of toxic shock syndrome in a 25-year-old man whose lower back had been stung by a bee [5].

Their patient had a pustular lesion with peripheral induration at the site of the sting; culture of a specimen from the lesion yielded Staphylococcus aureus. The patient exhibited classic signs of toxic shock syndrome, but he recovered relatively quickly.

Richardson and Schmitz [6] reported a case of chronic relapsing cervicofacial necrotizing fasciitis caused by a bee sting on the eyelid of a 61-year-old patient with diabetes.

The patient had group A β-hemolytic Streptococcus sepsis and severe necrotizing deep fascial infection of the neck and face, which assumed a relapsing course. This led to temporary multisystem organ failure that required intensive medical care and multiple surgical procedures that excised a major amount of facial tissue.

Ultimately, however, the disease was not fatal. Anderson et al.

[7] reported a case of disseminated infection with numerous microorganisms, including Pseudomonas aeruginosa, Enterococcus faecalis, Xanthomonas maltophila, and coagulase-negative Staphylococcus species, in a 4-year-old girl who had massive breakdown of the skin as a result of eosinophilic cellulitis (Wells' syndrome) after a bee sting to the left foot. Finally, Shahar and Frand [4] reported a case of Pseudomonas aeruginosa arthritis and osteomyelitis of the foot in a 10-year-old boy whose foot had been stung by a bee [4]. In that case, the infection appears to have remained localized.

Insect bites can lead to severe infections, including necrotizing fasciitis [8]. However, the extent to which bees contribute to this problem is virtually unknown.

No field studies have been performed to determine the degree to which bees are contaminated by pathogenic microorganisms, and the exact sequence of events that lead to infection of bee stings is unknown.

Several mechanisms can be suggested.

The abdomen of the honeybee is covered with numerous hairs, most of them branched and plume [9], to which pathogenic bacteria could attach. It is known that honeybees are occasionally attracted by garbage [3], which may further contaminate them with pathogens.

The sting of the honeybee is a complex organ, consisting of a stylet, 2 barbed lancets, and a venom sac.

When the bee uses its sting, the sting becomes deeply embedded in the skin and briskly advances by alternating the thrusts of both lancets, which, because of the direction of their barbs, can only move forward. Meanwhile, the venom from the sac is injected into the victim.

Eventually, the entire stinging mechanism detaches from the body of the bee (which kills the bee); however, because of the automatism of the intrinsic muscles, the lancets continue to advance, and the venom is continuously pumped [3, 9].

In this manner, any bacteria on either the insect's body or its sting, or on the surface of the victim's skin, can be inoculated under the epidermis. Unless carefully removed, the sting remains in the wound and may facilitate introduction of the infection.

The venom of the honeybee contains numerous enzymes and biologically active substances [3], which produce, among other effects, extensive local swelling and degranulation of mast cells.

Itching is usually associated with the sting [10], and scratching can cause further epidermal injury and intradermal implantation of pathogenic bacteria.

Furthermore, the edema surrounding the sting site may temporarily impair lymphatic drainage and reduce clearance of the infection by the immune system.

In brief, there are numerous mechanisms by which bee stings can cause local and systemic infection. The case we describe has several important features. First, the infection progressed remarkably rapidly and caused the patient to die. There was no evidence to suggest that our patient was immunocompromised.

The reasons for his cardiac surgery, unfortunately, were unavailable. His cardiac function may have been impaired before the infection, although there were no specific myocardial changes or coronary artery lesions, which could have led to a more precipitous circulatory collapse and death.

Second, it is unknown whether establishment of a local infection in the patient's heart was related to the presence of the pacemaker electrodes.

Finally, although the subcutaneous inflammation in the patient's extremities was diagnosed as cellulitis at the time of autopsy, it is possible that the development of necrotizing fasciitis in this patient was either imminent or ongoing.

This is particularly possible because sepsis was severe and because group A β-hemolytic Streptococcus species have a propensity to cause necrotizing fasciitis. Further research is needed to determine the relationship between honeybee stings and infection.


Brief Reports


How to Treat Insect Bites and Stings

Bites and Stings: Animals | Johns Hopkins Medicine

Most reactions to insect bites and stings are mild, causing little more than redness, itching, and stinging or minor swelling. Usually, the symptoms disappear in a day or two.1

However, in the case of an allergic reaction, or the rare event that an insect bite or sting from an insect causes a severe reaction, please call 911 or a doctor.

Severe reactions include difficulty in breathing or swallowing, swelling of the lips, eyelids, or throat, dizziness, faintness or confusion, rapid heartbeat, hives, nausea, or vomiting.1,2 You should also contact a doctor if the bite or sting appears to be infected.

Signs include redness with or without pus, warmth, fever, or a red streak that spreads out from the bite/sting.3

Immediate treatment for an Insect Bite or Sting:

Move to a safe place, to avoid more bites or stings.If stung, remove the stinger as quickly as possible.

Wash the area with soap and water to remove any substances left behind from the insect.3

Avoid scratching the bite or sting, as that may cause a break in the skin.3

Dermoplast for Whenever Insect Bites & Stings Happen:

  • stings from insects
  • itching from mosquito bites
  • pain from swelling of bug bites

After initially taking care of the insect bite or sting, it’s important to keep the area clean to reduce the chance of infection. The following steps can help:

  • Wash the area with clean water twice daily
  • Try to prevent opening the wounded area through scratching, which can lead to infection3,4

Relieving Pain and Itching

Even though the symptoms of insect bites and stings are mild, and temporary, they can cause a lot of discomfort. The pain and itching can be addressed in a number of ways:

  • Put a cold compress or cloth-wrapped ice pack on the bite or sting
    • Apply ice packs for 10 minutes on 10 minutes off. Repeat this process 3 to 6 times2,4
  • If stung or bitten on the arm or leg, elevate it to decrease the swelling4
  • You can take an oral antihistamine (Benadryl, others) to reduce itching, redness, and swelling. Use as directed.
    • Don’t give antihistamines to your child unless you’ve checked with a doctor first2,3,4
  • Using Dermoplast Pain & Itch Spray as directed can help with the pain and itching
  • Applying hydrocortisone cream or calamine lotion, as directed, to the bite or sting can also help relieve the inflammation, redness, and itching1,3

Symptoms to Watch for When Treating at Home:

Call your doctor if any of the following occur:

  • You have symptoms of an allergic reaction, such as:
    • A rash or hives (raised, red areas on the skin)
    • Itching
    • Swelling
    • Difficulty breathing
    • Belly pain, nausea, or vomiting
  • Swelling increases around the site (such as your entire arm or leg is swollen)
  • Signs of infection:
    • Increased pain, swelling, redness, or warmth around the sting.
    • Red streaks leading from the area
    • Pus draining from the sting
    • Flu- symptoms develop
  • Symptoms become more severe or more frequent2,3

Dermoplast products also provide relief from:

Dermoplast March 7, 2019


Bites and Stings: Animals

Bites and Stings: Animals | Johns Hopkins Medicine

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All animal bites need to be properly cleaned, and most need treatment the type and severity of the wound. Whether the bite is from a family pet or an animal in the wild, scratches and bites can become infected and cause scarring.

Animals can also carry diseases that can be transmitted through a bite. Bites that break the skin and bites of the scalp, face, hand, wrist, or foot are more ly to become infected. Cat scratches, even from a kitten, can carry “cat scratch disease,” a bacterial infection.

Other animals can transmit rabies and tetanus. Rodents such as mice, rats, squirrels, chipmunks, hamsters, guinea pigs, gerbils, and rabbits are at low risk of carrying rabies, but they can transmit other diseases.

The most common type of animal bite is a dog bite. Follow these guidelines to help decrease the chance of your child being bitten by an animal:

  • Never leave a young child alone with an animal.
  • Teach your child not to tease or hurt an animal.
  • Teach your child to avoid strange dogs, cats, and other animals.
  • Have your pets licensed and immunized against rabies and other diseases.
  • Keep your pets in a fenced yard or secured to a leash.

How to respond to dog or cat bites and scratches

When your child is bitten or scratched by an animal, remain calm and reassure your child that you can help. Your healthcare provider will determine specific treatment for an animal bite. Treatment may include:

  • For superficial bites from a familiar household pet that is immunized and in good health:
    • Wash the wound with soap and water under pressure from a faucet for at least 5 minutes. Do not scrub as this may bruise the tissue. Apply an antiseptic lotion or cream.
    • Watch for signs of infection at the site, such as increased redness or pain, swelling, or drainage, or if your child develops a fever. Call your child's healthcare provider right away if any of these occur.
  • For deeper bites or puncture wounds from any animal, or for any bite from a strange animal:

    • If the bite or scratch is bleeding, apply pressure to it with a clean bandage or towel to stop the bleeding.
    • Wash the wound with soap and water under pressure from a faucet for at least 5 minutes. Do not scrub as this may bruise the tissue.
    • Dry the wound and cover it with a sterile dressing. Do not use tape or butterfly bandages to close the wound as this could trap harmful bacteria in the wound.
    • Call your child's healthcare provider for help in reporting the attack and to decide if additional treatment, such as antibiotics, a tetanus booster, or rabies vaccine is needed. This is especially important for bites on the face or for bites that cause deeper puncture wounds of the skin.
    • If possible, locate the animal that inflicted the wound. Some animals need to be captured, confined, and observed for rabies. Do not try to capture the animal yourself. Contact the nearest animal warden or animal control office in your area.
    • If the animal can't be found or is a high-risk species (raccoon, skunk, or bat), or the animal attack was unprovoked, your child may need a series of rabies shots.

Call your child's healthcare provider for any flu- symptoms such as fever, headache, malaise, decreased appetite, or swollen glands following an animal bite.


Bites and Stings: Insects

Bites and Stings: Animals | Johns Hopkins Medicine

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Fleas, mites, and chiggers often bite humans, but are not poisonous. It is sometimes difficult to assess which type of insect caused the bite, or if the rash is caused by poison ivy or other skin conditions.

What are the symptoms of a flea, mite, or chigger bite?

The following are the most common symptoms of a flea, mite, or chigger bite. However, each individual may experience symptoms differently. Symptoms may include:

  • Small, raised skin lesions
  • Pain or itching
  • Dermatitis (inflammation of the skin)
  • Allergic-type reactions in hypersensitive people with swelling or blistering

The symptoms of a flea, mite, or chigger bite may resemble other conditions or medical problems. Always talk with your healthcare provider for a diagnosis.

Treatment for bites caused by fleas, mites and chiggers

Specific treatment for these insect bites will be discussed with you by your healthcare provider. Some general guidelines for treatment may include the following:

  • Clean the area well with soap and water.
  • Use an antihistamine, if needed, for itching.
  • Take acetaminophen, if needed, for discomfort.

When should I call my healthcare provider?

Call your healthcare provider if any, or all, of the following symptoms are present:

  • Persistent pain or itching
  • Signs of infection at the site, such as increased redness, warmth, swelling, or drainage
  • Fever

Call 911 or your local emergency medical service (EMS) if the individual has signs of a severe allergic reaction such as trouble breathing, tightness in the throat or chest, feeling faint, dizziness, hives, and/or nausea and vomiting.

Tick bites

Ticks are small insects that live in grass, bushes, wooded areas, and along seashores. They attach their bodies onto a human or animal host and prefer hairy areas such as the scalp, behind the ear, in the armpit and groin, and also between fingers and toes. Tick bites often happen at night and happen more in the spring and summer months.

What to do if you find a tick on your child

Recommendations for removing a tick include the following: 

  • Do not touch the tick with your bare hand. If you do not have a pair of tweezers, take your child to your nearest healthcare facility where the tick can be removed safely.
  • Use a pair of tweezers to remove the tick. Grab the tick firmly by its mouth or head as close to your child's skin as possible.
  • Pull up slowly and steadily without twisting until it lets go. Do not squeeze the tick, and do not use petroleum jelly, solvents, knives, or a lit match to kill the tick.
  • Save the tick and place it in a plastic container or bag so it can be tested for disease, if necessary.
  • Wash the area of the bite well with soap and water and apply an antiseptic lotion or cream.
  • Call your child's healthcare provider to find out about follow-up care.

Regardless of how careful you are about animals in your home, or how many precautions you take when your child is outdoors playing, animal and insect bites and stings are sometimes unavoidable.

By remaining calm and knowing some basic first aid techniques, you can help your child overcome both the fear and the trauma of bites and stings.

Facts about insect stings

Bees, wasps, yellow jackets, and hornets belong to a class of insects called Hymenoptera. Most insect stings cause only minor discomfort. Stings can happen anywhere on the body and can be painful and frightening for a child.

Yellow jackets cause the most allergic reactions in the U.S. Stings from these insects cause 3 to 4 times more deaths than poisonous snake bites, due to severe allergic reaction.

Fire ants, usually found in southern states, can sting multiple times, and the sites are more ly to become infected.

The 2 greatest risks from most insect stings are allergic reaction (which can sometimes be fatal if the allergic reaction is severe enough) and infection (more common and less serious).

What are the symptoms of an insect sting?

The following are the most common symptoms of insect stings. However, each child may experience symptoms differently. Symptoms may include:

  • Local skin reactions at the site or surrounding the sting, including the following:
    • Pain
    • Swelling
    • Redness
    • Itching
    • Warmth
    • Small amounts of bleeding or drainage
    • Hives
  • Generalized symptoms that indicate a more serious and possibly life-threatening allergic reaction, including the following:

    • Coughing
    • Tickling in the throat
    • Tightness in the throat or chest
    • Breathing problems or wheezing
    • Nausea or vomiting
    • Dizziness or fainting
    • Sweating
    • Anxiety
    • Itching and rash elsewhere on the body, remote from the site of the sting

Treatment for stings

Specific treatment for stings will be discussed with you by your child's healthcare provider. Large local reactions usually do not lead to generalized reactions. However, they can be life-threatening if the sting happens in the mouth, nose, or throat area. This is due to swelling that can close off the airway.

Treatment for local skin reactions only may include:

  • Calm your child and let him or her know that you can help.
  • Remove the stinger, if present, by gently scraping across the site with a blunt-edged object, such as a credit card or dull knife. Do not try to pull it out, as this may release more venom.
  • Wash the area well with soap and water.
  • Apply a cold or ice pack wrapped in a cloth to help reduce swelling and pain (10 minutes on and 10 minutes off for 30 to 60 minutes).
  • If the sting happens on an arm or leg, elevate the limb to help reduce swelling.
  • To help reduce the itching, consider the following:
    • Apply a paste of baking soda and water and leave it on for 15 to 20 minutes.
    • Apply a paste of nonseasoned meat tenderizer and water and leave it on for 15 to 20 minutes.
    • Apply a wet tea bag and leave it on for 15 to 20 minutes.
    • Use an over-the-counter product made to use on insect stings.
    • Apply an antihistamine or corticosteroid cream or calamine lotion.
    • Give acetaminophen for pain.
    • Give an over-the-counter antihistamine, if approved by your child's healthcare provider. Be sure to follow dosage instructions carefully for your child.
    • Observe your child closely for the next hour for any signs of allergic reaction that would warrant emergency medical treatment.

Call 911 or your local emergency medical service (EMS) and seek emergency care immediately if your child is stung in the mouth, nose, or throat area, or for any signs of a systemic or generalized reaction.

Emergency medical treatment may include the following:

  • Intravenous (IV) antihistamines
  • Epinephrine
  • Corticosteroids or other medicines
  • Lab tests
  • Breathing support

Prevention of insect stings

Some general guidelines to help reduce the possibility of insect stings while outdoors include:

  • Avoid perfumes, hairsprays, and other scented products.
  • Avoid brightly colored clothing.
  • Do not let your child walk or play outside barefoot.
  • Spray your child's clothing with insect repellent made for children.
  • Make sure your child avoids locations of hives and nests. Have the nests removed by professionals.
  • Teach your child that if an insect comes near to stay calm and walk away slowly.

Some additional preventive measures for children who have a known or suspected allergy to stings include the following:

  • Carry a bee sting kit (such as EpiPen) at all times and make sure your child knows how to use it. These products are available by prescription.
  • Make sure your child wears long-sleeve shirts and long pants when playing outdoors.
  • See an allergist for allergy testing and treatment.


Hymenoptera stings: A practical guide to prevention and management

Bites and Stings: Animals | Johns Hopkins Medicine

DR. KRAKOWSKI is a clinical research fellow in pediatric dermatology at the University of California, San Diego. He is also the founder and director of the Johns Hopkins School of Medicine's annual wilderness medicine course.

DR. GOLDEN is professor of allergy and immunology at Johns Hopkins Medical Institute, Baltimore.

Staff editors: JULIA RUSSELL, Managing Editor, and JOHN BARANOWSKI, Editor, Contemporary Pediatrics

Staff editors, manuscript reviewers, and Dr. Krakowski have nothing to disclose in regard to affiliations with, or financial interests in, any organization that may have an interest in any part of this article. Dr.

Golden reports that he is a consultant to Genentech, receives research support from ALK-Abello Labs, and is on the speakers' bureau for Dey Labs, ALK-Abello Labs and for Genentech; all of these have products on the market that are relevant to insect sting anaphylaxis.

The warm weather that lures children outdoors with bare arms, legs, and, sometimes, feet is also the time when insects are most active and insect populations highest. Insects are attracted to the same fruits and flowers that attract the curious child, and to that child's sweet summertime treats.

A child's curiosity and naiveté may lead him to put his nose—and hands—in places that adults know by experience to avoid. He may step barefoot on a patch of clover visited by a honeybee, or may misinterpret nature's warning signs as an invitation to investigate or play.

His small size and relative inability to escape his surroundings also leave him more vulnerable to a serious situation when stinging insects attack.

A child is less ly than an adult is to have a systemic reaction to a sting, or to have a repeat systemic reaction to re-stings. Not all children, however, outgrow insect sting allergy.

1-6 One study found that one in five patients who had a systemic allergic reaction to a sting as a child had a similar reaction to a sting even more than three decades later.

6 This finding suggests that physicians and parents must pay close attention to preventive measures including weighing the risks and benefits of venom immunotherapy in high-risk patients.

The usual suspects

Most clinically significant reactions related to insects arise not from biting bugs but from the business end of stinging insects of the order Hymenoptera. The families Apidae (honeybees and bumblebees), Vespidae (yellow jackets, yellow hornets, white-faced hornets, paper wasps) and the formidable Formicidae (fire ants) are the major culprits in the United States.

The small, fuzzy honeybee (Apis mellifica) is not typically aggressive, but may sting a child if trapped underfoot, in the hair, or in loose clothing. It is attracted to flowers, sweat, and some sweet-smelling perfumes and syrups.

The africanized honeybee (also known as the “killer bee”) first arrived in the Southwestern United States from Mexico in 1990, after traveling up from Brazil.

Its nickname derives not from any greater venom potency or allergenicity, but rather from its tendency to attack in swarms after minimal provocation.

Although even incidents of 50 to 100 stings are not usually fatal, 42 deaths were attributed to africanized honeybees between 1987 and 1991 in Mexico. In the United States, 13 deaths have been attributed to them by 2002.7,8

Compared with the smaller honeybee, the large, slow-moving bumblebee
(Bombus spp) is fairly noisy (think, Bzzzzzzzz), and, typically, nonaggressive. Its sting accounts for only a small percentage of those to humans.

The yellow jacket (Vespula spp) is identified by the alternating black and yellow stripes on its body.

It lives in fairly large colonies of at least 500 workers in ground nests or in the crevices of natural and residential structures and mainly scavenges for meat and sweet ripe fruit or fruit syrup).

It becomes most aggressive during the decline of the colony's life cycle in late summer and autumn.

The yellow hornet and white-faced hornet (both of them Dolichovespula spp) are closely related to the yellow jacket: Both live in colonies of at least 1,500 workers and build teardrop-shaped nests that hang from trees or bushes. Both are extremely sensitive to vibration, such as from lawn tractors and mowers and hedge trimmers. All are highly aggressive, particularly when defending the nest.

The paper wasp (Polistes spp) builds a papier-mâché- nest in shade, often beneath eaves, gutters, or window frames. The colony is comparatively small, with 10 to 25 wasps. It is more prevalent in the Southern United States than in the Northeastern states.7