How to Figure out What Insect Stung You

Insect Stings Archives – New Mexico

How to Figure out What Insect Stung You

In 1989,an article in Hospital Practice by Ovary  stated that the death of Pharaoh Menes after a wasp sting in 2600 BC was the first reported account of an anaphylactic reaction to insect stings.  According toKrombach, this was hieroglyphs found on his sarcophagus and tomb.

Dynasties that came after Menes believed him to be the first Pharaoh and he is credited with many things, including the introduction of papyrus and writing.  ButKrombach and his fellow authors argue that he was ly a mythical figure who may not have even lived.  Oh well — so much for exotic origins.

  No matter when the first reaction was, it is ly that insect sting allergy started a very long time ago.Statistics
A review article in the June 2015 Journal of Allergy and Clinical Immunology In Practice spoke about the state of the art in treating stinging insect allergy.

Reactions to stinging insects account for 10% of all cases of anaphylaxis presenting to emergency rooms and there are about 40 deaths per year in the US due to these reactions. The estimate is that 0.4% to 0.8% of children and 2% to 3.

5% of the general adult population experience systemic reactions to insect stings at some point in their lives.

The Players

The Hymenoptera are the most studied stinging insects, with purified, commercial venoms for testing and treatment in the United States. Hymenoptera include the Apidae (honeybee) and Vespidae (aerial yellow jacket or New World hornets) which include Vespinae (yellow jackets and aerial yellow jackets) and Polistinae (wasps).

There are also a number of types of stinging ants. The most common in the US and best studied is the Imported Fire Ant (IFA), Solenopsis  invicta.

Since inadvertent importation through Mobile, Alabama during 1930-1940, this fire ant has spread throughout the Southeast of the US as far north as Maryland and even into the arid southwest.

What are the different kinds of reactions to insect stings?

There are five types of reactions to insect stings, according to Koterba and Greenberger. These include:

·    A normal reaction with less than 2 inches of redness and swelling right around the sting and which subsides in less than a day.  For this, cold compresses and analgesics (pain medication) are sufficient treatment.·    A large local reaction with extensive redness and swelling, generally more than 5 inches in size and lasting 1-10 days.

  These reactions can involve large areas – for example, a whole arm. Analgesics, ice and sometimes prednisone is the usual treatment.·    Anaphylaxis includes swelling that skips a joint area or occurs at areas of the body distant from the site of the sting.  Hives can also accompany this reaction.

  The patient may have life threatening symptoms such as swelling of the larynx (which may cut off breathing) or cardiac involvement.  Treatment includes urgent use of epinephrine (generally administered by an automatic injector such as EpiPen or Auvi Q) and calling EMS for a trip to the emergency room.

Patients who have these reactions should be skin tested and considered for desensitization to the venom or venoms to which they are shown to be allergic.  If the reaction is only hives in a child less than 16 years old, life threatening reactions usually do not develop on re-sting so desensitization may not be necessary in this case.

·    Rare reactions: These include serum sickness with hives, fever, malaise and joint pain that occurs 7 days after the sting.  Some of these patients may experience anaphylaxis on subsequent stings, so desensitization is suggested.

·    Toxic  reactions: These happen with multiple simultaneous stings such as may occur in an attack by Africanized honey bees. Hypotension, cardiovascular collapse and death may occur.

How can you tell which kind of insect stung you?

There are five types of stinging insects to which allergists test – Yellow Jacket, Honeybee, White Faced Hornet, Yellow-Faced Hornet,  and Wasp.  According to the American Academy of Asthma, Allergy and Immunology, here are some of the characteristics of these insects:

•    Yellow jackets are black with yellow markings, found in various climates. Their nests are usually located underground, but sometimes found in the walls of buildings, cracks in masonry or in woodpiles.•    Honeybees have round, fuzzy bodies with dark brown and yellow markings. They can be found in honeycombs in trees, old tires or other partially protected sites.

Honeybees are the only Hymenoptera insects that leave their stinger in the skin after a sting.•    Paper wasps are slender with black, brown, red and yellow markings. They live in a circular comb under eaves, behind shutters or in shrubs and woodpiles.•    Hornets are black or brown with white, orange or yellow markings.

Their nests are gray or brown and are usually found in trees.

Why is it important for you to be able to identify the type of insect that stung you when you have had a reaction?  It is important because your allergist at Allergy Partners uses this information in conjunction with skin tests to determine which type of venom to use for desensitization.

It is very important for the doctor to get a good history, including what type of insect was involved and the details of the reaction. Identification of the type of insect that caused the reaction through history and skin testing as well as the nature of the reaction can be lifesaving.

Is there anything that can be done?

Skin tests to stinging insects can show false negatives in up to 20% of cases, and so blood tests may then be helpful.   In some cases, it is important to get a baseline tryptase level.  If elevated, it may make the sting reaction more severe.

  If you are skin test positive to one or more venoms after you have had a systemic or anaphylactic reaction to an insect sting, your allergist can prescribe desensitization injections which will reduce the lihood of a reaction to 3% from 60%.

The exception is in children  under 16 who have only had skin reactions (usually hives) as these patients generally do not progress to more severe reactions with subsequent stings.  It takes about 15 injections, barring local or systemic reactions to the shots, to get to a “maintenance” dose.

  Once maintenance is reached, injections can be given once per month during the first year and every 6-8 weeks during the subsequent years. Venom immunotherapy is typically given for 5 years, but may be continued for a longer duration in certain instances.
Your Allergy Partners physician will work with you to determine the best course for you.


Bug Bites and Stings

How to Figure out What Insect Stung You

Bug bites and stings usually are just annoying, causing temporary discomfort and pain, but no serious or lasting health problems. But sometimes, they can cause infections that require treatment and allergic reactions that can be serious, even fatal.

Parents should know the signs of an infection or allergic reaction, and when to get medical care. Inform all caregivers if a child has any history of problems so they know what to do in the event of a bug bite or sting.

Handling Bee and Wasp Stings

  • A bee will usually leave behind a stinger attached to a venom sac. Try to remove it as quickly as possible using a scraping motion, without pinching the venom sac at the end. (Wasps don't leave their stingers in the skin after stinging, which means they can sting more than once.


  • Wash the area carefully with soap and water. Do this two to three times a day until the skin is healed.
  • Apply an ice pack wrapped in a cloth or a cold, wet washcloth for a few minutes.
  • Give acetaminophen or ibuprofen for pain.

  • For pain and itching, give an over-the-counter oral antihistamine if your child's health care provider says it's OK; follow dosage instructions for your child's age and weight. You could also apply a corticosteroid cream or calamine lotion to the sting area.
  • A sting anywhere in the mouth needs immediate medical attention because this can quickly cause severe swelling that may block airways.
  • Get medical care if you notice a large skin rash or swelling around the sting site, or if swelling or pain lasts for more than 3 days, which could be signs of an infection.
  • The following signs may indicate a serious or potentially life-threatening allergic reaction.

    Use an epinephrine auto-injector if it's available, and call 911 right away if you notice:

    • wheezing or trouble breathing
    • tightness in throat or chest
    • swelling of the lips, tongue, or face
    • dizziness or fainting
    • nausea or vomiting

If your child has had an allergic reaction to a bee or wasp sting in the past, see your health care provider for a prescription for an epinephrine auto-injector.

Handling Spider Bites

  • Wash the area carefully with soap and water. Do this two to three times a day until skin is healed.
  • Apply cool compresses.
  • Give acetaminophen or ibuprofen for pain.
  • To protect against infection, apply an antibiotic ointment and keep your child's hands washed.
  • If you have any reason to suspect a bite by a black widow spider or brown recluse spider, use soap and water to wash the bite site, apply a cold compress or ice wrapped in a washcloth, and take your child to the emergency room. Even if he or she doesn't show any symptoms, get medical attention right away.

    Most spiders found in the United States are harmless, with the exception of the black widow and the brown recluse spider. The brown recluse spider — a tiny oval brown spider with a small shape a violin on its back — is found mostly in midwestern and southern parts of the United States.

    This spider s to hide in dark, quiet places in attics or garages, under porches, and in woodpiles. The bites usually don't hurt at first (a child might not even be aware of the bite), but in some cases they cause swelling, changes in skin color, and a blister, which can later scar.

    Chills, fever, rash, pain, nausea, and rarely, more serious symptoms seizures or coma can follow a bite.

    The black widow spider, which is found all over North America, has a shiny black body and an orange-red hourglass shape on its underbelly. The venom (a toxic substance) in a black widow bite can cause painful cramps that show up within a few hours of the bite.

    The cramps can start in the muscles around the bite and then spread. The bite may also lead to nausea, vomiting, chills, fever, headache, and muscle aches. If your child has any of these symptoms — or you think he or she has been bitten — go to the emergency room right away.

Handling Scorpion Stings

Another sting to look out for is one caused by a scorpion.

  • Wash the area with soap and water, apply a cold compress or ice wrapped in a washcloth on the sting, and take your child to the emergency room immediately.

If a person gets stung by a scorpion, the area of the sting will hurt and may get swollen or red, depending on the type of scorpion. More severe reactions from the venom involving other parts of the body also can happen.

Because it's hard to tell a dangerous scorpion from one that is harmless, all scorpion stings must be treated by a health care provider. Capture the scorpion for identification if it's possible to do so safely, and bring it with you. Knowing the type of scorpion that caused the bite may make treatment easier.

Handling Tick Bites

Check kids and pets for ticks carefully after they've been in or around a wooded area. Ticks removed within 24 to 48 hours are less ly to transmit diseases Lyme disease. Common types of ticks include dog ticks and deer ticks (deer ticks may be carriers of Lyme disease).

If you find a tick on your child:

  • Call your health care provider, who may want you to save the tick in a sealed container or zip-locked bag for identification later.
  • Use tweezers to grasp the tick firmly at its head or mouth, next to the skin.
  • Pull firmly and steadily upward on the tick until it lets go (do not twist or jerk the tick), then swab the bite site with alcohol.
  • Don't use petroleum jelly or a lit match to kill and remove a tick. These methods don't get the tick off the skin, and may cause the insect to burrow deeper and release more saliva (which increases the chances of disease transmission).

Preventing Bites and Stings

Here are some ways to protect your family from bites and stings:

  • Prevent flea infestations by treating your house (including all carpets, furniture, and pets) regularly during the warmer months. Frequent vacuuming also can help.
  • Avoid mosquitoes by staying away from areas where mosquitoes breed, such as still pools or ponds, during hot weather. Remove standing water from birdbaths, buckets, etc.; try to stay inside when mosquitoes are most active (dawn and dusk); and apply insect repellent when kids go outside.
  • When in tick country, stay in the center of trails, avoiding woody areas with high grass. Check kids for ticks every few hours and as soon as you come inside. Remove any you find immediately. The most important places to check are behind the ears, on the scalp, on the back of the neck, in the armpits, in the groin area, and behind the knees. Have kids shower as soon as they come in from outdoors. Check your pets when they come inside, too. Use tick products on pets to prevent them from being bitten.
  • Use insect repellent when spending time outdoors camping, hiking, etc. Repellents that contain 10% to 30% DEET (N,N-diethyl-meta-toluamide) are approved for mosquitoes, ticks, and some other bugs. Repellents that contain picaridin (KBR 3023) or oil of lemon eucalyptus (p-menthane 3,8-diol or PMD) are effective against mosquitoes. Follow the instructions carefully. Check what ages the product is appropriate for, and don't overuse it — using more than is needed won't provide any extra protection. Reapply insect repellent according to the directions after swimming.
  • When you or your kids are in wooded areas, tuck clothes in and keep as covered up as possible. Tuck pants into socks and shirts into pants. Wear shoes and socks when walking on grass, even it's just for a minute. Bees and wasps can sting unprotected feet.
  • Wear gloves when gardening.
  • Don't disturb bee or wasp nests.
  • Don't swat at buzzing insects — they will sting if they feel threatened.
  • Be aware that spiders might be hiding in undisturbed piles of wood, seldom-opened boxes, or corners behind furniture, and proceed with caution.

Reviewed by: Larissa Hirsch, MD

Date reviewed: September 2016