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The first step in treatment following a bee sting is removal of the stinger itself. The stinger should be removed as quickly as possible without regard to method: studies have shown the amount of venom delivered does not differ whether the sting is pinched or scraped off and even a delay of a few seconds leads to more venom being injected. Once the stinger is removed, pain and swelling should be reduced with a cold compress. A topical anesthetic containing benzocaine will kill pain quickly and menthol is an effective anti-itch treatment. Itching can also be relieved by antihistamine or by a steroid cream.
Many traditional remedies have been suggested for bee stings including damp pastes of tobacco, salt, baking soda, papain, toothpaste, clay, garlic, urine, onions, aspirin or even application of copper coins. As with jellyfish stings, ammonia and ammonia-containing liquids, such as window cleaner, are often suggested as a way to immediately cleanse the skin and remove excess venom, and sweat itself (which also contains small amounts of ammonia) may provide some small relief.
Bee venom is acidic, and these interventions are often recommended to neutralize the venom; however, neutralizing a sting is unlikely to be effective as the venom is injected under the skin and deep into the tissues, where a topically applied alkali is unable to reach, so neutralization is unlikely to occur. In any case, the amount of venom injected is typically very small (between 5 and 50 micrograms of fluid) and placing large amounts of alkali near the sting site is unlikely to produce a perfectly neutral pH to stop the pain. Many people do claim benefit from these home remedies but it is doubtful they have any real physical effect on how much a sting hurts or continues hurting. The effect is probably related to rubbing the area or the mind perceiving benefit. Furthermore, none of these interventions have been proven to be effective in scientific studies and a randomized trial of aspirin paste and topical ice packs showed that aspirin was not effective in reducing the duration of swelling or pain in bee and wasp stings, and significantly increased the duration of redness. The study concluded that ice alone is better treatment for bee and wasp stings than aspirin.
The sting may be painful for a few hours. Swelling and itching may persist for a week. The area should not be scratched as it will only increase the itching and swelling. If swelling persists for over a week or covers an area greater than , medical attention should be sought. Doctors often recommend a tetanus immunization. For about 2 percent of people, a hypersensitivity can develop after being stung, creating a more severe reaction when stung again later. This sensitisation may happen after a single sting, or after a series of stings where they reacted normally. A highly allergic person may suffer anaphylactic shock from certain proteins in the venom, which can be life-threatening and requires emergency treatment. People known to be highly allergic may carry around epinephrine (adrenaline) in the form of a self-injectable EpiPen for the treatment of an anaphylactic shock.
For patients who experience severe or life-threatening reactions to insect stings, allergy injections composed of increasing concentrations of naturally occurring venom may provide protections against future insect stings.
Effective management of allergic diseases relies on the ability to make an accurate diagnosis. Allergy testing can help confirm or rule out allergies. Correct diagnosis, counseling, and avoidance advice based on valid allergy test results reduces the incidence of symptoms and need for medications, and improves quality of life. To assess the presence of allergen-specific IgE antibodies, two different methods can be used: a skin prick test, or an allergy blood test. Both methods are recommended, and they have similar diagnostic value.
Skin prick tests and blood tests are equally cost-effective, and health economic evidence shows that both tests were cost-effective compared with no test. Also, early and more accurate diagnoses save cost due to reduced consultations, referrals to secondary care, misdiagnosis, and emergency admissions.
Allergy undergoes dynamic changes over time. Regular allergy testing of relevant allergens provides information on if and how patient management can be changed, in order to improve health and quality of life. Annual testing is often the practice for determining whether allergy to milk, egg, soy, and wheat have been outgrown, and the testing interval is extended to 2–3 years for allergy to peanut, tree nuts, fish, and crustacean shellfish. Results of follow-up testing can guide decision-making regarding whether and when it is safe to introduce or re-introduce allergenic food into the diet.
The majority of individuals who receive a sting from an insect experience local reactions. It is estimated that 5-10% of individuals will experience a generalized systemic reaction that can involve symptoms ranging from hives to wheezing and even anaphylaxis. In the United States approximately 40 people die each year from anaphylaxis due to stinging insect allergy. Potentially life-threatening reactions occur in 3% of adults and 0.4–0.8% of children.
A bee sting is a sting from a bee (honey bee, bumblebee, sweat bee, etc.). The stings of most of these species can be quite painful, and are therefore keenly avoided by many people.
Bee stings differ from insect bites, and the venom or toxin of stinging insects is quite different. Therefore, the body's reaction to a bee sting may differ significantly from one species to another. In particular, bee stings are acidic, whereas wasp stings are alkali, so the body's reaction to a bee sting may be very different than to that of a wasp sting.
The most aggressive stinging insects are vespid wasps (including bald-faced hornets and other yellow jackets) and hornets (especially the Asian giant hornet). All of these insects aggressively defend their nests.
Although for most people a bee sting is painful but otherwise relatively harmless, in people with insect sting allergy, stings may trigger a dangerous anaphylactic reaction that is potentially deadly. Additionally, honey bee stings release pheromones that prompt other nearby bees to attack.
An allergy blood test is quick and simple, and can be ordered by a licensed health care provider ("e.g.", an allergy specialist), GP, or PED. Unlike skin-prick testing, a blood test can be performed irrespective of age, skin condition, medication, symptom, disease activity, and pregnancy. Adults and children of any age can take an allergy blood test. For babies and very young children, a single needle stick for allergy blood testing is often more gentle than several skin tests.
An allergy blood test is available through most laboratories. A sample of the patient's blood is sent to a laboratory for analysis, and the results are sent back a few days later. Multiple allergens can be detected with a single blood sample. Allergy blood tests are very safe, since the person is not exposed to any allergens during the testing procedure.
The test measures the concentration of specific IgE antibodies in the blood. Quantitative IgE test results increase the possibility of ranking how different substances may affect symptoms. A rule of thumb is that the higher the IgE antibody value, the greater the likelihood of symptoms. Allergens found at low levels that today do not result in symptoms can nevertheless help predict future symptom development. The quantitative allergy blood result can help determine what a patient is allergic to, help predict and follow the disease development, estimate the risk of a severe reaction, and explain cross-reactivity.
A low total IgE level is not adequate to rule out sensitization to commonly inhaled allergens. Statistical methods, such as ROC curves, predictive value calculations, and likelihood ratios have been used to examine the relationship of various testing methods to each other. These methods have shown that patients with a high total IgE have a high probability of allergic sensitization, but further investigation with allergy tests for specific IgE antibodies for a carefully chosen of allergens is often warranted.
Laboratory methods to measure specific IgE antibodies for allergy testing include enzyme-linked immunosorbent assay (ELISA, or EIA), radioallergosorbent test (RAST) and fluorescent enzyme immunoassay (FEIA).
There are three main classifications of anaphylaxis. Anaphylactic shock is associated with systemic vasodilation that causes low blood pressure which is by definition 30% lower than the person's baseline or below standard values. Biphasic anaphylaxis is the recurrence of symptoms within 1–72 hours with no further exposure to the allergen. Reports of incidence vary, with some studies claiming as many as 20% of cases. The recurrence typically occurs within 8 hours. It is managed in the same manner as anaphylaxis. Pseudoanaphylaxis or anaphylactoid reactions are a type of anaphylaxis that does not involve an allergic reaction but is due to direct mast cell degranulation. Non-immune anaphylaxis is the current term used by the World Allergy Organization with some recommending that the old terminology no longer be used.
Allergy testing may help in determining the trigger. Skin allergy testing is available for certain foods and venoms. Blood testing for specific IgE can be useful to confirm milk, egg, peanut, tree nut and fish allergies.
Skin testing is available to confirm penicillin allergies, but is not available for other medications. Non-immune forms of anaphylaxis can only be determined by history or exposure to the allergen in question, and not by skin or blood testing.
The cause of chronic hives can rarely be determined. In some cases regular extensive allergy testing over a long period of time is requested in hopes of getting new insight. No evidence shows regular allergy testing results in identification of a problem or relief for people with chronic hives. Regular allergy testing for people with chronic hives is not recommended.
Insect sting allergy is the term commonly given to the allergic response of an animal in response to the bite or sting of an insect. Typically, insects which generate allergic responses are either stinging insects (wasps, bees, hornets and ants) or biting insects (mosquitoes, ticks). Stinging insects inject venom into their victims, whilst biting insects normally introduce anti-coagulants into their victims.
The great majority of insect allergic animals just have a simple allergic response – a reaction local to the sting site which appears as just a swelling arising from the release of histamine and other chemicals from the body tissues near to the sting site. The swelling, if allergic, can be helped by the provision of an anti-histamine ointment as well as an ice pack. This is the typical response for all biting insects and many people have this common reaction.
Mosquito allergy may result in a collection of symptoms called skeeter syndrome that occur after a bite. This syndrome may be mistaken for an infection such as cellulitis.
In anaphylactic patients the response is more aggressive leading to a systemic reaction where the response progresses from the sting site around the whole body. This is potentially something very serious and can lead to anaphylaxis, which is potentially life-threatening.
This very rare form of angioedema develops in response to contact with vibration. In vibratory angioedema, symptoms develop within two to five minutes after contact with a vibrating object, and abate after about an hour. Patients with this disorder do not suffer from dermographism or pressure urticaria. Vibratory angioedema is diagnosed by holding a vibrating device such as a laboratory vortex machine against the forearm for four minutes. Speedy swelling of the whole forearm extending into the upper arm is also noted later. The principal treatment is avoidance of vibratory stimulants. Antihistamines have also been proven helpful.
Sunscreen and protective clothing should also be used during the hottest part of the day to avoid blisters from sunburn. Avoiding sunlight during midday is the best way to avoid blisters from sunburn. Protective gloves should be worn when handling detergents, cleaning products, solvents and other chemicals.
The most serious and rare form of latex allergy, Type I hypersensitivity can cause an immediate and potentially life-threatening reaction, not unlike the severe reaction some people have to bee stings. Such reactions account for a significant proportion of perioperative anaphylactic reaction, especially in children with myelomeningocele. Type I natural rubber latex allergy is an IgE (immune) mediated reaction to proteins found in the "Hevea brasiliensis" tree, a type of rubber tree.
Testing for type I natural rubber latex allergy is through blood testing to determine if the patient is producing IgE antibodies to latex proteins.
Anaphylactic shock can be provoked in allergic persons by the "previous" use of latex in an area: latex is typically powdered to prevent sticking, latex proteins become attached to the particles of powder, and the powder becomes airborne when the latex item is used, triggering potentially life-threatening Type I reactions when the latex-contaminated powder is inhaled by susceptible persons.
In radiological units latex allergy may mimic contrast medium allergy
Friction blisters, caused by rubbing against the skin, can be prevented by reducing the friction to a level where blisters will not form. This can be accomplished in a variety of ways.
Blisters on the feet can be prevented by wearing comfortable, well-fitting shoes and clean socks. Inherently ill-fitting or stiffer shoes, such as high heels and dress shoes, present a larger risk of blistering. Blisters are more likely to develop on skin that is moist, so socks that manage moisture or frequent sock changes will aid those with particularly sweaty feet. While exercising or playing sports, special sports socks can help keep feet drier and reduce the chance of blisters. Before going for a long walk, it is also important to ensure that shoes or hiking boots have been properly broken in.
Even before a "hot" or irritated area on the foot is felt, taping a protective layer of padding or a friction-reducing interface between the affected area and the footwear can prevent the formation of a blister. Bandages, moleskin and tapes generally must be applied to the foot daily, and most have a very high coefficient of friction (COF), but a friction-management patch applied to the shoe will remain in place much longer, throughout many changes of socks and insoles. This type of intervention may be used with footwear that is worn daily, with specialty shoes and boots like hockey skates, ice skates, inline skates, ski boots and cleats, or even with orthotic braces and splints. For periods of sustained use such as hiking and trail running, especially where water ingress or moisture build up in the shoe or boot can occur, moisture wicking liner socks can provide the required friction protection.
To avoid friction blisters on the hands, gloves should be worn when using tools such as a shovel or pickaxe, doing manual work such as gardening, or using sports equipment like golf clubs or baseball bats. Oars used for competitive rowing are known for causing frequent blisters on the hands of oarsmen. Weightlifters are also prone to blisters as are gymnasts from the friction developed by the rubbing against the bars. To further reduce the occurrence one can tape the hands, and there are also a number of products on the market that claim to reduce the occurrence of blisters. These are all intended to be worn as a liner underneath a glove. The majority of these offerings simply add padding and create a layer that reduces the coefficient of friction between the skin and the glove.
A lubricant, typically talcum powder, can be used to reduce friction between skin and apparel in the short term. People put talcum powder inside gloves or shoes for this purpose, although this type of lubricant will increase the friction in the long term, as it absorbs moisture. Increased friction makes blisters more likely.
Ant venom is any of, or a mixture of, irritants and toxins inflicted by ants. Most ants spray or inject a venom, the main constituent of which is formic acid only in the case of subfamily Formicinae.
Type IV allergy, also known as allergic contact dermatitis, involves a delayed skin rash that is similar to poison ivy with blistering and oozing of the skin ("see urushiol-induced contact dermatitis"). It can be diagnosed through a positive skin patch test, although a negative test does not rule out a latex allergy.
Severe irritation takes place if a latex catheter is inserted in the urinary tract of a person allergic to latex. That is especially severe in case of a radical prostatectomy due to the open wound there and the exposure lasting e.g. two weeks. Intense pain may indicate such situation.
Insect bites and stings occur when an insect is agitated and seeks to defend itself through its natural defense mechanisms, or when an insect seeks to feed off the bitten person. Some insects inject formic acid, which can cause an immediate skin reaction often resulting in redness and swelling in the injured area. Stings from fire ants, bees, wasps and hornets are usually painful, and may stimulate a dangerous allergic reaction called anaphylaxis for at-risk patients, and some wasps can also have a powerful bite along with a sting. Bites from mosquitoes and fleas are more likely to cause itching than pain.
The skin reaction to insect bites and stings usually lasts for up to a few days. However, in some cases the local reaction can last for up to two years. These bites are sometimes misdiagnosed as other types of benign or cancerous lesions.
The histomorphologic appearance of insect bites is usually characterized by a wedge-shaped superficial dermal perivascular infiltrate consisting of abundant lymphocytes and scattered eosinophils. This appearance is non-specific, i.e. it may be seen in a number of conditions including:
- Drug reactions,
- Urticarial reactions,
- Prevesicular early stage of bullous pemphigoid, and
- HIV related dermatoses.
There are only rare examples of stinging ants. Some notable examples include "Solenopsis" (fire ants), "Pachycondyla", "Myrmecia" (bulldog ants), and "Paraponera" (bullet ants). In the case of fire ants, the venom consists of alkaloid and protein components. Stinging ants cause a cutaneous condition that is different from that caused by biting venomous ants. Particularly painful are stings from fire ants, although the bullet ant's sting is considered by some to be the most painful insect sting.
First aid for fire ant bites includes external treatments and oral medicines.
- External treatments: a topical steroid cream (hydrocortisone), or one containing "Aloe vera"
- Oral medicines: antihistamines
- Applying zinc oxide or calamine lotion .
Severe allergic reactions can be caused by ant stings in particular and venomous stings in general, including severe chest pain, nausea, severe sweating, loss of breath, serious swelling, fever, dizziness, and slurred speech; they can be fatal if not treated.
Lab testing is necessary for definitive diagnosis, but a good field test is to touch a dead larva with a toothpick or twig. It will be sticky and "ropey" (drawn out). Foulbrood also has a characteristic odor, and experienced beekeepers with a good sense of smell can often detect the disease upon opening a hive. However, this odour may not be noticeable until the disease is in an advanced stage. Since response and treatment is required as early as possible to protect other colonies, absence of odour cannot be relied on as indicating absence of foulbrood. Only regular and thorough inspection of the brood can identify the disease in its early stages.
The most reliable disease diagnosis is done by sending in some possibly affected brood comb to a laboratory specialized in identifying honey bee diseases.
Treatment may include corticoids, astringents, and keratolytics. Dermatoses tend to be recurrent unless the use or contact can be avoided. Discontinuation of the instrument is curative in almost all cases, but usually impractical.
Many species of arthropods (insects, arachnids and others) regularly or occasionally bite or sting human beings. Insect saliva contains anticoagulants and enzymes that cause local irritation and allergic reactions. Insect venoms can be delivered by their stingers, which often are modified ovipositors, or by their mouthparts. Insect, spider and scorpion venom can cause serious injury or death. Dipterans account for the majority of insect bites, while hymenopterans account for the majority of stings. Among arachnids spider bites are the most common. Arthropods bite or sting humans for a number of reasons including feeding or defense. Arthropods are major vectors of human disease, with the pathogens typically transmitted by bites.
Cutaneous disorders in musicians include frictional injury ("fiddler's neck"), hyperhidrosis, acne mechanica and vascular compromise. Other agents of irritant and allergic contact dermatitis may be rosewood, Makassar ebony, cocobolo wood, African blackwood, nickel, reed, propolis (bee glue), chromium and paraphenylenediamine. Patch testing can be performed for identification of the cause.
Scorpion stings are a cutaneous condition caused by the stinging of scorpions, usually resulting in pain, paresthesia, and variable swelling. The anatomical part of the scorpion that delivers the sting is called a "telson".
Most scorpion stings vary from small swelling to medically significant lesions in severity, with only a few able to cause severe allergic, neurotic or necrotic reactions. Only two species of scorpions can inflict stings which result in death of normal healthy humans: the Israeli deathstalker ("Leiurus quinquestriatus") and the "Brazilian yellow scorpion" (Tityus serrulatus). Antivenom exists for both species' stings.
Apitoxins are under preliminary research for their potential biological effects, such as in cancer.
Antibiotics, in non-resistant strains of the pathogen, can prevent the vegetative state of the bacterium forming. Drug treatment to prevent the American foulbrood spores from successfully germinating and proliferating is possible using oxytetracycline hydrochloride (Terramycin).
Another drug treatment, tylosin tartrate, was approved by the US Food and Drug Administration (FDA) in 2005.
Chemical treatment is sometimes used prophylactically, but this is a source of considerable controversy because certain strains of the bacterium seem to be rapidly developing resistance. In addition, hives that are contaminated with millions of American foulbrood spores have to be prophylactically treated indefinitely. Once the treatment is suspended the American foulbrood spores germinate successfully again leading to a disease outbreak.
Because of the persistence of the spores (which can survive up to 40 years), many State Apiary Inspectors require an AFB diseased hive to be burned completely. A less radical method of containing the spread of disease is burning the frames and comb and thoroughly flame scorching the interior of the hive body, bottom board and covers. Dipping the hive parts in hot paraffin wax or a 3% sodium hypochlorite solution (bleach) also renders the AFB spores innocuous. It is also possible to sterilize an infected hive without damaging either the structure of the hive or the stores of honey and pollen it contains by sufficiently lengthy exposure to an atmosphere of ethylene oxide gas, as in a closed chamber, as hospitals do to sterilize equipment that cannot withstand steam sterilization.
Brigham Young University is currently studying the use of phage therapy to treat American foulbrood.