Bee stings: Is it an allergic reaction?

A bit about bees

Bees are members of the family Apidae. The most commonly encountered types of bees are honey bees (Apis mellifera) and bumble bees (genus Bombus). Both are important pollinators, and honey bees are the source of honey consumed by humans and many other animals (both real and cartoon). Normally, bees are not aggressive, but they will sting when they feel threatened.

In the 1950s, honey bees from Africa were brought to Brazil in an unsuccessful attempt to increase honey production. After escaping the laboratory, they mated with the local bee population and their descendants slowly spread northward and can now be found in several southwestern US states. These “Africanized” honey bees exhibit highly defensive behavior, particularly when their hive is threatened. They do not seek out people to attack unprovoked, although it may seem that way when someone unknowingly disturbs a hive.

When they perceive a threat, Africanized honey bees may respond in large numbers and pursue the threat for greater distances than other honey bees. Their venom is not more poisonous than that of other honey bees. Rather, the danger comes from the large number of stings that can occur in a short period of time, resulting in a much greater venom dose. This behavior earned them the nickname “killer bees.”

What happens when a bee stings you?

When a bee stings, it uses a sharp hollow tube to penetrate the skin and inject its venom. Honey bee stingers are barbed and stay in the skin as the bee tries to fly away. When the bee escapes, the stinger is torn from the bee along with the bee’s venom sac and part of its digestive tract. This results in the death of the honey bee.  

Only female honey bees can sting. Male honey bees, known as drones, do not have stingers, but they may fly up near your face to menace you if you disturb the hive’s activities. When a female honey bee stings, she releases an alarm pheromone that signals to other honey bees that a threat is present. This pheromone—which smells like bananas to people—can attract other bees to the threat, potentially resulting in multiple stings.

Unlike honey bees, bumble bees have smooth stingers that do not become embedded in the skin. Because they retain their stingers, bumble bees can sting more than once.

Symptoms of bee stings

Bee stings usually result in immediate pain, a raised central bump, and an area of reddened skin and swelling surrounding the bump. These symptoms can last for hours or up to a few days. A person who is stung multiple times can develop headache, fever, nausea and dizziness. More than 10% of people will respond to a bee sting with a large local reaction (LLR). LLRs produce areas of redness and swelling 4 inches or more in diameter. LLRs start small but expand over 2 days and can last up to 10 days.

Severe, life-threatening allergic reactions (anaphylaxis) can occur within minutes after a bee sting. Symptoms of anaphylaxis include trouble breathing, chest tightness, swelling of the lips, tongue, or throat, hives, fast pulse and low blood pressure, dizziness, fainting, and nausea and vomiting.

Always tell your healthcare providers about your reactions to any bite or sting.

How do you treat a bee sting?

The first step in treating a honey bee sting is to remove the stinger. This can be done by scraping it with a credit card or the back of a knife held perpendicular to the skin. Historically, people were told not to remove the stinger using pinched fingers or tweezers because it would squeeze the venom sac and inject more venom. There does not seem to be any solid scientific evidence to support this. Fingers are clumsy extraction tools and people are more likely to have immediate access to a credit card than tweezers.

After the stinger is removed, wash the sting site with soap and water. Apply ice wrapped in a wet cloth to relieve pain and swelling. Over-the-counter pain relievers such as ibuprofen and acetaminophen, and antihistamines such as diphenhydramine, can provide additional temporary relief.

People with LLRs might need several days of treatment with a corticosteroid such as prednisone to reduce the inflammation.

How to treat anaphylaxis

Anaphylaxis is a life-threatening medical emergency. Have the person lie down on their side and call 911 as soon as any symptoms of anaphylaxis appear. If an epinephrine auto-injector such as EpiPen is available, follow the instructions for preparation and inject the contents into the outer part of the middle thigh. Epinephrine nasal spray such as Neffy can also be used. Tell EMS responders about any action you have taken.