Bites and Stings: Insects

Insect Stings

Bites and Stings: Insects | Johns Hopkins Medicine

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The 2 greatest risks from most insect stings are allergic reaction (which can be fatal in some people) and infection (more common and less serious).

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. Most stings are from honey bees or yellow jackets. Fire ants, usually found in southern states, can sting multiple times. The sites of the stings are more ly to become infected.

What are the symptoms of an insect sting?

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

  • Local reactions at the site, including:
    • Pain
    • Swelling
    • Redness
    • Itching
    • Warmth
    • Hives
  • Serious symptoms that indicate the possibly of a life-threatening allergic reaction, include:

    • Coughing
    • Tickling in the throat
    • Tightness in the throat or chest
    • Breathing problems or wheezing
    • Nausea or vomiting
    • Dizziness or fainting
    • Sweating
    • Anxiety
    • Hives over a large part of the body

What is the treatment for insect stings?

Large, local reactions do not usually lead to more serious generalized reactions. However, they can be life-threatening if the sting happens in the mouth, nose, or throat area. Swelling in these areas can cause breathing difficulties.

Treatment for local skin reactions may include the following:

  • Remove the stinger by gently scraping across the site with a blunt-edged object, such as a credit card, a dull knife, or a fingernail. 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 thin cloth to help reduce swelling and pain (10 minutes on and 10 minutes off for a total of 30 to 60 minutes).
  • If the sting happens on an arm or leg, keep the arm or leg raised to help reduce swelling.
  • To help reduce the pain and 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 for 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 healthcare provider.
    • Watch the person closely for the next hour for more serious symptoms.

Call 911 or your local emergency medical service (EMS) for immediate care if the sting was in the mouth, nose, or throat area, or if any other serious symptoms happen.

Emergency medical treatment may include the following:

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

Preventing insect stings

To reduce the possibility of insect stings while outdoors, try the following:

  • Avoid using perfumes, hair products, and other scented items.
  • Avoid brightly colored clothing.
  • Do not go outside barefoot. Avoid wearing sandals in the grass.
  • Use insect repellent.
  • Avoid locations where hives and nests are present. Have the nests removed by professionals.
  • If an insect comes near, stay calm and walk away slowly.

If you have a known or suspected allergy to stings, you should:

  • Carry a bee sting kit (such as EpiPen) at all times and know how to use it. These products are available by prescription.
  • Wear a medical alert bracelet or necklace with your allergy information.
  • Wear long-sleeve shirts and long pants when outdoors.
  • Talk with your healthcare provider about seeing an allergist for allergy testing and treatment.



Bites and Stings: Insects | Johns Hopkins Medicine

Did you get allergy shots before 1979 to protect against stings from yellow jackets, bees, wasps or hornets?

Chances are they didn't do you any good. The material with which you probably were injected, an extract of crushed whole insect bodies, has since been shown to be entirely ineffective.

And if you were skin-tested for sting allergy before 1979, those results may not be accurate. The same extract was used for skin tests and wasn't good for that, either.

On a cheerier note, all you who diligently have gotten shots since 1979 to combat sting allergies have bought some very good protection. The purified insect venoms used for shots and skin tests since then are thought to be 98-99 percent effective.

Cheeriest of all, many patients may be able to stop the shots some day. So far, most patients have been told to keep getting their sting allergy shots indefinitely unless a subsequent skin test shows they're no longer allergic. But evidence is growing that years of shots may actually provide long-lasting protection, even if the allergy itself remains.

The three leading centers studying insect sting allergy, the Mayo Medical School, Johns Hopkins University and State University of New York at Buffalo, are experimenting with stopping shots after several years, so far with good results. Their data aren't ready to be codified in recommendations for allergists, but that may not be far off.

“I'm reasonably optimistic; I don't think this necessarily has to be a lifetime treatment,” said Dr. John W. Yunginger of the Mayo Medical School in Rochester, Minn.

Stopping shots would save untold time, sore arms and a lot of money. The first year of insect sting shots, not including testing and evaluation, typically costs about $800 for a single venom. Subsequent years, when shots are given less often, run about $500 each. It's more expensive if you need more than one type of venom.

Deciding when treatment can safely be stopped is far more than a matter of cost and convenience, however; it can mean life or death. Un most other allergies, insect allergy can cause a life-threatening disruption to breathing and circulatory systems called anaphylactic shock. It also can cause nausea, wheezing and dizziness.

Dr. Paul J. Hannaway, an allergist in Salem and Danvers, Mass.

, and past president of the Massachusetts Allergy Society, says he's willing to stop shots for patients who have never had a life-threatening reaction, have taken venom shots for five years, had a recent negative skin test and have had several stings without ill effect. But, he says, “We're not stopping anyone who's had a life-threatening reaction until someone can guarantee us a way to make sure the patient doesn't become resensitized.”

The American Academy of Allergy and Immunology, an allergists' group, estimates 1 million to 2 million Americans have severe insect sting allergies. Each year, 40 to 50 deaths from sting reactions are reported, but more deaths may be occurring that are mistakenly attributed to heart attacks.

The cost is high in psychological terms, too. People allergic to stings often are warned to keep emergency epinephrine kits nearby at all times, and they may be so fearful of being stung that they curb outdoor activities.

The shots work by providing successively larger doses of venom until patients are getting as much or more than a sting's worth. Shots don't eliminate the allergy; people who have been immunized may still be allergic, but wouldn't get a severe reaction if they were stung.

Often, allergies fade or disappear over time on their own, especially in children. People who got shots of the old, ineffective insect extracts are advised to be retested. If they prove still allergic, a new series of shots might be recommended.


Lupus-Specific Skin Disease and Skin Problems

Bites and Stings: Insects | Johns Hopkins Medicine

Most people with lupus experience some sort of skin involvement during the course of their disease. In fact, skin conditions comprise 4 of the 11 criteria used by the American College of Rheumatology for classifying lupus. There are three major types of skin disease specific to lupus and various other non-specific skin manifestautions associated with the disease.

Lupus-Specific Skin Disease

Three forms of specific skin disease occur in people with lupus, and it is possible to have lesions of multiple types.

In addition, a person can also have one of the three forms outlined below without actually having full-blown systemic lupus erythematosus (SLE), but the presence of one of these disease forms may increase a person’s risk of developing SLE later in life.

Usually, a skin biopsy is used to diagnose forms of cutaneous lupus, and various medications are available for treatment, including steroid ointments, corticosteroids (e.g., prednisone), and antimalarials (e.g., Plaquenil).

Chronic Cutaneous Lupus Erythematosus (CCLE) / Discoid Lupus Erythematosus (DLE)

Chronic cutaneous (discoid) lupus erythematosus is usually diagnosed when someone exhibits signs of lupus in the skin. People with SLE can also have discoid lesions, and about 5% of all people with DLE will develop SLE later in life.

A skin biopsy is used to diagnose this condition, and the lesions have a characteristic pattern known to clinicians: they are thick and scaly, plug the hair follicles, appear usually on surfaces of the skin exposed to sun (but can occur in non-exposed areas), tend to scar, and usually do not itch.

If you are diagnosed with discoid lupus, you should try to avoid sun exposure when possible and wear sunscreen with Helioplex and an SPF of 70 or higher. In addition, you doctor may prescribe medications to help prevent and curb inflammation, including steroid ointments, pills, or injections , antimalarial medications such as Plaquenil, and/or immunosuppressive medications.

Subacute Cutaneous Lupus Erythematosus (SCLE)

About 10% of lupus patients have SCLE. The lesions characteristic of this condition usually do not scar, do not appear thick and scaly, and usually do not itch. About half of all people with SCLE will also fulfill the criteria for systemic lupus.

Treatment can be tricky because SCLE lesions often resist treatments with steroid creams and antimalarials.

People with SCLE should be sure to put on sunscreen and protective clothing when going outdoors in order to avoid sun exposure, which may trigger the development of more lesions.

Acute Cutaneous Lupus Erythematosus (ACLE)

Most people with ACLE have active SLE with skin inflammation, and ACLE lesions are found in about half of all people with SLE at some point during the course of the disease.

The lesions characteristic of ACLE usually occur in areas exposed to the sun and can be triggered by sun exposure.

Therefore, it is very important that people with ACLE wear sunscreen and protective clothing when going outdoors.

Malar Rash

About half of all lupus patients experience a characteristic rash called the malar or “butterfly” rash that may occur spontaneously or after exposure to the sun. This rash is so-named because it resembles a butterfly, spanning the width of the face and covering both cheeks and the bridge of the nose.

The malar rash appears red, elevated, and sometimes scaly and can be distinguished from other rashes because it spares the nasal folds (the spaces just under each side of your nose). The butterfly rash may appear on its own, but some people observe that the appearance of the malar rash indicates an oncoming disease flare.

Whatever the case, it is important to pay attention to your body’s signals and notify your physician of anything unusual.


50% of all people with lupus experience sensitivity to sunlight and other sources of UV radiation, including artificial lighting. For many people, sun exposure causes exaggerated sunburn- reactions and skin rashes, yet sunlight can precipitate lupus flares involving other parts of the body. For this reason, sun protection is very important for people with lupus.

Since both UV-A and UV-B rays are known to cause activation of lupus, patients should wear sunscreen containing Helioplex and an SPF of 70 or higher. Sunscreen should be applied everywhere, including areas of your skin covered by clothing, since most clothing items contain an SPF of only about 5.

Be sure to reapply as directed on the bottle, since sweat and prolonged exposure can cause coverage to dissipate.

Livedo reticularis

People with lupus may experience a lacy pattern under the skin called livedo reticularis. This pattern may range anywhere from a violet web just under the surface of the skin to something that looks a reddish stain.

Livedo can also be seen in babies and young women, is more prominent on the extremities, and is often accentuated by cold exposure.

The presence of livedo is usually not a cause for alarm, but it can be associated with antiphospholipid antibodies.


About 70% of people with lupus will experience hair loss (alopecia) at some point during the course of the disease. Hair loss in lupus is usually characterized by dry, brittle hair that breaks, and hair loss is more common around the top of the forehead. Physical and mental stress can also cause hair loss, as can certain medications, including corticosteroids such as prednisone.

In many cases the hair will grow back, but hair loss due to scarring from discoid skin lesions may be permanent. There is no cure-all for hair loss, but treatments such as topical steroids and Rogaine may be prescribed. Sometimes dealing with the cosmetic side effects of lupus can be difficult, but some people find using hairpieces and wigs to be an effective means of disguising hair loss.

Oral and Nasal Ulcers

About 25% of people with lupus experience lesions that affect the mouth, nose, and sometimes even the eyes. These lesions may feel small ulcers or “canker sores.

” Such sores are not dangerous but can be uncomfortable if not treated.

If you experience these types of lesions, your doctor may give you special mouthwash or Kenalog in Orabase (triamcinolone dental paste) to help expedite the healing process.

Raynaud’s Phenomenon

Approximately one-third of all people with lupus experience a condition called Raynaud’s phenomenon in which the blood vessels supplying the fingers and toes constrict. The digits of people with Raynaud’s are especially susceptible to cold temperatures.

Often people with the condition will experience a blanching (loss of color) in the digits, followed by blue, then red discoloration in temperatures that would only be mildly uncomfortable to other people (such as a highly air-conditioned room).

It is very important that people with Raynaud’s wear gloves and socks when in air-conditioned spaces or outside in cool weather. Hand warmers used for winter sports (e.g., Hot Hands) can also be purchased and kept in your pockets to keep your hands warm.

These measures are very important, since Raynaud’s phenomenon can cause ulceration and even tissue death of the fingers and toes if precautions are not taken. People have even lost the ends of their fingers and toes due to the poor circulation involved in Raynaud’s phenomenon.

Cigarettes and caffeine can exacerbate the effects of Raynaud’s, so be sure to avoid these substances. If needed, your doctor may also recommend a calcium channel blocker medication such as nifedipine or amlodipine to help dilate your blood vessels.

Hives (Urticaria)

About 10% of all people with lupus will experience hives (urticaria). These lesions usually itch, and even though people often experience hives due to allergic reactions, hives lasting more than 24 hours are ly due to lupus.

If you experience this condition, be sure to speak with your doctor, since s/he will want to be sure that the lesions are not caused by some other underlying condition, such as vasculitis or a reaction to medication.

Your doctor will probably distinguish these lesions from those caused by vasculitis by touching them to see if they blanch (turn white).


Approximately 15% of people with lupus will experience purpura (small red or purple discolorations caused by leaking of blood vessels just underneath the skin) during the course of the disease. Small purpura spots are called petechiae, and larger spots are called eccymoses. Purpura may indicate insufficient blood platelet levels, effects of medications, and other conditions.

Cutaneous Vasculitis

Some people with lupus may develop a condition known as cutaneous vasculitis, in which the blood vessels near the skin experience inflammation that ultimately restricts blood flow. This condition can cause hive- lesions on the skin that may itch and do not turn white when depressed.

Other skin abnormalities may also be present, including actual gangrene of the digits. If left untreated, vasculitic lesions may cause ulceration and necrosis (cell death), and dead tissue must be surgically removed. Rarely, fingers or toes with aggressive ulceration and gangrene may require amputation.

Therefore, it is very important that you notify your doctor of any skin abnormalities.