Introduction

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Mild localized itching, swelling, or discomfort requires a call your health care provider for advice.

Worsening of local symptoms over a few days may be evidence of infection at the sting site. Pain, increased swelling and redness, and warmth suggest an infection.In this situation immediately consult a physician.

If you had a reaction in the past, even if you used an epinephrine injection kit for this sting, go immediately to nearer hospital in emergency department. Even if you have treated yourself, you still need to be evaluated to make sure that your symptoms are resolving and are not recurring.

Hives or rash or swelling all over your body, difficulty breathing or swallowing, or dizziness or fainting suggest an anaphylactic reaction. This requires immediate medical attention.

• If you have these severe symptoms over your entire body, you should go to a hospital in emergency department.
• Do not drive yourself to the hospital.
• If no one is available to drive you right away, call 911 for emergency medical transport. If you are able, tell the dispatcher that you are having a reaction to a sting.
• While waiting for the ambulance, take self-treatment measures.

Self-Care at Home

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For most insect stings, home care is all that is necessary.

• If insects are on or around you, remain calm.
• Gently brush any insects from your skin.
• Quietly leave the area as quickly as you can.
• If the stinger is still lodged in the skin, as it usually is after honeybee stings, it should be removed promptly.
• You can do this by scraping the site with a credit card or similar device, perpendicular to the skin. A fingernail can be used.
• Pinching the stinger to pull it out is not advised, because this may inject more venom.
• Control local swelling
• Elevate the part of the body where the sting is located.
• Apply ice to the area of the sting.
• If the sting is on the hands or feet where rings or other tight-fitting jewelry is worn, these should be removed immediately before swelling develops, to avoid any compression of the blood supply to these areas.
• Control pain: Ibuprofen (Advil) or acetaminophen (Tylenol) is usually sufficient to relieve pain.
• Treat the itch
• Take an antihistamine pill, such as diphenhydramine (Benadryl). This helps counteract one of the mediators of the reaction and will help control itching. Diphenhydramine is available without a prescription. Caution - this medication makes most people too drowsy to drive or operate machinery safely. It can be taken every 6 hours for the first few days, until the swelling begins to improve.
• Hydrocortisone cream, available over-the-counter, can be applied to the site of the insect sting to relieve itching.
• A paste of baking soda or salt and water, rubbed on the skin, may provide relief.
• An over-the-counter lotion such as Calamine can help.
• If a blister develops at the site, keep the area clean but do not break the blister.

Do not be alarmed if the reaction takes 2-5 days to heal. Continue treatment until all symptoms are gone.

For more severe reactions, self-treatment is not recommended. Call your health care provider or 911, depending on the severity of your symptoms. Do not attempt to drive yourself. If no one is available to drive you right away, call for an ambulance. If you have symptoms of anaphylaxis, here's what you can do while waiting for the ambulance:

• Try to stay calm.
• Remove yourself from the area where the insects are.
• Take an antihistamine (1-2 tablets or capsules of diphenhydramine [Benadryl]) if you can swallow without difficulty.
• If you are wheezing or having difficulty breathing, use an inhaled bronchodilator such as albuterol (Proventil) or epinephrine (Primatene Mist) if one is available. These inhaled medications dilate the airway.
• If you are feeling light-headed or faint, lie down and raise your legs higher than your head to help blood flow to your brain.
• If you have been given an epinephrine kit, inject yourself as you have been instructed. The kit provides a premeasured dose of epinephrine, a prescription drug that rapidly reverses the most serious symptoms (see Follow-up).
• Bystanders should administer CPR to a person who becomes unconscious and stops breathing or does not have a pulse.
• If at all possible, you or your companion should be prepared to tell medical personnel which medications you have taken today, which you usually take, and any known allergies.

Follow-up

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Make sure that all of your health care providers are aware of the type of reaction you have had.

If you have had a severe or all-over reaction, you should be given a prescription for an epinephrine injection kit (EpiPen) when you leave the hospital.

• This is a premeasured dose of epinephrine in an easy-to-use syringe.
• You would inject yourself in the thigh muscle with the epinephrine at the first sign of a reaction.
• Someone at your medical office can show you how to use the kit. Clear instructions are also provided at the web site of the food allergy & anaphylaxis network.
• It is recommended that you keep 2 or more of these kits at different locations and that you keep one with you at all times in case of a sting.

if you have a severe or all-over reaction to an insect sting, you should see an allergy specialist (allergist). Desensitization therapy is available for some types of venom allergies.

Prevention

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Take precautions to avoid insect stings in the future.

• Avoid nests or hives of stinging insects.
• Do not wear bright clothing or perfumes that might attract bees and wasps.
• Remain calm and quiet around flying insects. Move slowly.
• Take special care when around food or drinks outdoors, as at cookouts or picnics. Stinging insects are attracted to foods, especially sweet foods such as soft drinks.

Evaluation by an allergist for desensitization injections has been shown to be of benefit. Obtain one or more epinephrine injection kits if this has been prescribed for you.

• Keep the kit(s) in convenient locations and have one near you at all times
• Read the instructions right away and review them often.
• It is important that you be able to get to the kit and use it quickly in case of a reaction.
• Make sure your family members and closest friends know how to use the kit as well.
• Any time this device is used, you must go immediately afterward to your health care provider or to a hospital emergency department.