Bee, wasp, hornet, or yellow jacket sting

Bee, wasp, hornet, and yellow jacket stings contain a substance called venom. The venom from each type of insect contains several chemicals. Bee and hornet venom contain histamine.

Of these insects, Africanized bee colonies are very sensitive to being disturbed. When they are disturbed, they respond faster and in greater numbers than other types of bees. They are also much more likely to sting than European bees.

You are also at risk for stings if you disturb a wasp, hornet, or yellow jacket nest.

Bee, wasp, hornet, and yellow jacket venom can cause an allergic reaction in some people.

Below are symptoms of a bee, wasp, hornet, or yellow jacket sting in different parts of the body.

EYES, EARS, NOSE, AND THROAT

• Swelling in the throat, lips, tongue, and mouth *

HEART AND BLOOD VESSELS

• Rapid heart rate
• Severe decrease in blood pressure*
• Collapse (shock) *

LUNGS

• Difficulty breathing *

SKIN

• Hives *
• Itching
• Swelling and pain at site of the sting

STOMACH AND INTESTINES

• Abdominal cramping
• Diarrhea
• Nausea and vomiting

* These symptoms are due to an allergic reaction, and not venom.

If you have an allergy to stings from a bee, wasp, yellow jacket, or similar insect you should always carry an insect sting kit and know how to use it. These kits require a prescription. They contain a medicine called epinephrine, which you should take right away if you get a bee, wasp, hornet, or yellow jacket sting.

Call poison control or a hospital emergency room if the person who is stung has an allergy to the insect or was stung inside the mouth or throat. People with severe reactions may need to go to the hospital.

To treat the sting:

• Try to remove the stinger from the skin (if it is still present). To do this, carefully scrape the back of a knife or other thin, blunt, straight-edged object (like a credit card) across the stinger if the person can keep still and it is safe to do so. If you are pulling the stinger out, it is important to not pinch the venom sac at the end of the stinger. If this sac is squeezed or broken, more venom will be released.
• Clean the area thoroughly with soap and water.
• Place ice (wrapped in a clean cloth) on the site of the sting for 10 minutes and then off for 10 minutes. Repeat this process. If the person has problems with blood circulation, decrease the time that the ice is on the area to prevent possible skin damage.
• Keep the affected area still, if possible, to prevent the venom from spreading.
• Loosen clothing and remove rings and other tight jewelry.
• Give the person diphenhydramine (Benadryl and other brands) by mouth if they can swallow. This antihistamine drug may be used alone for mild symptoms.

Have this information ready:

• Person's age, weight, and condition
• Type of insect, if possible
• Time of the sting
• Location of the sting

Your local poison control center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States. This national hotline will let you talk to experts in poisoning. They will give you further instructions.

This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

The health care provider will measure and monitor the person's vital signs, including temperature, pulse, breathing rate, and blood pressure. Symptoms will be treated. The person may receive:

• Blood and urine tests.
• Breathing support, including oxygen. Severe allergic reactions may require a tube down the throat and breathing machine (ventilator).
• Chest x-ray.
• ECG (electrocardiogram, or heart tracing).
• Intravenous fluids (IV, through a vein).
• Medicine to treat symptoms.

How well a person does depends on how allergic they are to the insect sting and how quickly they receive treatment. The faster they get medical help, the better the chance for recovery. The chances of future total body reactions increase when local reactions become more and more severe.

People who are not allergic to bees, wasps, hornets, or yellow jackets usually get better within 1 week.

DO NOT put your hands or feet in nests or hives or other preferred hiding places. Avoid wearing bright colored-clothing and perfumes or other fragrances if you will be in an area where these insects are known to gather.

Apitoxin; Apis venenum purum; Insect sting; Insect bite; Wasp sting; Hornet sting; Yellow jacket sting

Curtis AM, Erickson TB. Venomous animal injuries. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 53.

Erickson TB, Márquez A. Arthropod envenomation and parasitism. In: Auerbach PS, Cushing TA, Harris NS, eds. Auerbach's Wilderness Medicine. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 41.

Varney SM, Ahmed S. Bites and stings. In: Bakes KM, Buchanan JA, Moreira ME, Byyny R, Pons PT, eds. Emergency Medicine Secrets. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 73.

Updated by: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.