A bee sting may cause an allergic reaction or anaphylaxis. Symptoms of a severe allergic reaction can vary, but may include hives, a swollen throat or tongue, flushed skin, nausea, vomiting, dizziness, and more.

For most people, a bee sting only produces temporary pain and irritation at the site of the sting.

For others, bee stings cause an allergic reaction that can range from mild to severe. In extreme cases, a bee sting can cause life-threatening anaphylaxis.

In this article, we discuss the causes, symptoms, and treatment of bee sting allergies and how to avoid getting stung during the summer months.

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Approximately 5-7.5% of people will experience a severe allergic reaction to insect stings in their lifetimes. In beekeepers, this risk rises to 32%.

Many people who react to insect stings will experience a mild to moderate irritant reaction in the form of localized redness and swelling.

For a small minority of people, the allergic reaction can be much more severe, requiring emergency medical treatment. Fatal reactions are rare.

The venom of honeybees, paper wasps, and yellow jackets tends to cause the most severe allergic reactions.

Bees, wasps, and fire ants most commonly cause systemic allergic reactions, which spread all over the body, including to the skin and respiratory system.

When a bee stings, its sharp, barbed stinger remains lodged in the skin. This stinger can release venom for up to a minute after the bee has stung.

Bee venom contains proteins that affect the skin cells and immune system, resulting in pain and swelling at the site of the sting, even if a person is not allergic to the venom.

In those who are allergic to bee stings, the venom triggers a more severe immune system reaction. These people may not have an allergic reaction the first time they are stung but may have an allergic reaction to a second bee sting.

If a person is allergic, the bee sting will cause the immune system to produce a type of antibody called immunoglobulin E (IgE). Usually, IgE protects the body from dangerous substances, such as viruses and parasites.

However, in response to a sting, the body produces IgE that then causes inappropriate immune responses, such as hives, swelling, and respiratory problems the next time a person is stung.

Reactions to bee venom can range from mild to severe. In less severe cases, the reaction occurs around the site of the sting. In more severe cases, the allergic reaction affects other parts of the body.

How one individual reacts to a bee sting can also differ from one occasion to the next. Some people may find they have a localized reaction each time they are stung.

It is helpful to know the symptoms associated with different degrees of reactions so that a person can receive the appropriate treatment.

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Redness and swelling characterize a mild reaction.

The symptoms of a bee sting vary depending on how allergic the person is. A person can have a mild, moderate, or severe reaction shortly after being stung by a bee.

Mild reaction

The majority of bee sting symptoms are very mild and do not require medical attention. They are limited to the site of the sting itself, and include:

  • a sharp, burning pain
  • an area of raised, red skin
  • slight swelling

Moderate reaction

In a person with a moderate bee sting reaction, the body has a stronger response to bee venom, called a large local reaction (LLR). In such cases, the symptoms can take over a week to heal completely.

Symptoms include severe redness around the sting, as well as swelling around the sting, which may gradually increase in size to a diameter of 10 centimeters (cm)or more over a period of 24–48 hours

If a person experiences a LLR, there is a 5-10% risk that they will develop a systemic allergic reaction to a sting in the future.

Severe allergic reaction

In certain individuals, a bee sting can cause anaphylaxis, which is a life-threatening allergic reaction requiring emergency medical treatment. The following symptoms of anaphylaxis develop rapidly:

  • itchy, red hives on the skin
  • pale or flushed skin
  • a swollen throat or tongue
  • difficulty breathing
  • abdominal pain
  • nausea and vomiting
  • dizziness
  • a weak, rapid pulse
  • loss of consciousness

The treatment for bee sting reaction will depend upon the severity of the allergic reaction.

Treating a mild to moderate reaction

After a bee sting, remove the stinger as soon as possible, taking care to avoid squeezing the venom sac. Removing the stinger will limit the amount of venom released into the bloodstream. Tweezers should not be used to remove a stinger, since squeezing may release more venom.

Use a cold compress, apply steroid ointments, and take antihistamines to help reduce itchiness and inflammation.

Symptoms should subside over the course of a couple of days.

Treating a severe reaction

Severe, systemic reactions require an urgent shot of epinephrine, which will help to reduce the severity of the allergic reaction. Doctors may also administer oxygen and intravenous fluids.

If someone has an epinephrine injection device (EpiPen), they should use it immediately. Epinephrine temporarily reverses the symptoms of a severe allergic reaction. A person with a severe allergy should carry an EpiPen with them at all times.

Anyone experiencing one or more symptoms of anaphylaxis should get to an emergency room as soon as possible, even if they have self-administered epinephrine. Although rare, venom anaphylaxis can cause cardiac arrest within 5-10 minutes of being stung.

While waiting for the emergency services to arrive, the person should lay on their back with feet elevated. Doing so will help to counteract weakness and dizziness by assisting blood flow to the heart.

Long-term treatment

Desensitization immunotherapy is a treatment designed to reduce a person’s sensitivity to particular allergens. Someone who has had a severe allergic reaction to bee stings, or has other risk factors, can receive a form of this treatment known as venom immunotherapy (VIT).

VIT involves a course of injections of increasingly high doses of bee venom. Gradually increasing the dose over about 3 years helps the immune system build up a tolerance to the venom.

A 2015 review of VIT suggested VIT is an effective treatment for bee sting allergy. Those whose allergic reactions are severe should ask their doctor or allergist for further information about the treatment.

Those who are allergic to bee stings can take the following precautions to reduce their risk of being stung when outdoors:

  • avoiding walking in sandals or bare feet
  • ensuring arms and legs are covered
  • avoiding wearing clothing that is brightly colored or has a floral print
  • avoiding wearing strong perfumes
  • checking outdoor areas for bees and other flying insects before eating outside
  • when eating outdoors, keeping food covered and paying attention to foods and drinks that bees could land on
  • keeping windows closed when driving

If you come into contact with bees:

  • Do not swat at bees as they may sting in defense.
  • If a bee flies near you, try to move slowly and calmly away.
  • If a bee lands on you, try to remain calm as it will usually fly away within seconds.
  • If you find a bee or wasp nest in your house or garden, call a local pest control expert. Never attempt to remove a nest yourself.

Most bee stings will produce only mild and temporary symptoms that people can treat at home.

Even those who experience moderate reactions do not usually need to seek urgent medical attention. However, they may wish to speak with a doctor if they are concerned about future reactions to bee venom.

A person who experiences anaphylaxis after being stung by a bee is more likely to experience anaphylaxis when stung in the future. Doctors should prescribe an EpiPen for these people to use in emergencies. They may also wish to speak with their doctor about the possibility of venom immunotherapy treatment.