Battling the Bees and Bugs of Summer
Bug bites and insect stings are common during spring and summer months. When should you be concerned, and when does your child need medical help? And what over-the-counter medicines work best?
Bee Sting Reactions
The term “bee sting” is commonly used to refer to stings by honeybees, bumblebees, wasps, yellow jackets and any member of the order Hymenoptera. Fire ants are also a wingless member of this family. No matter the name, these insects are responsible for the majority of sting-related reactions.
Most people experience a mild local reaction limited to the area of tissue immediately surrounding the sting. There is an instant, burning pain at the site followed by redness and painful swelling within a few hours. In most people the swelling and pain resolve within two days.
Approximately 10 percent of people stung by bees will experience a “large local reaction.” This appears as extreme redness and swelling that enlarges over the next two days. The swelling can be up to 10 centimeters. Large local reactions tend to resolve within 10 days. Patients with this reaction are not at an increased risk of having a severe allergic reaction in the future.
A severe allergic reaction, or anaphylaxis, is the most dangerous immediate reaction to a sting and requires urgent medical attention. A small percentage of people stung by bees or other insects develop anaphylaxis. Signs and symptoms include skin reactions in parts of the body other than the sting area (including itching and flushing), difficulty breathing or hoarse voice, swelling of the tongue or throat, nausea, vomiting or diarrhea, and dizziness or fainting.
How to Treat Bee Stings
Quick removal of the stinger, often left behind in the child’s skin, is very important. The stinger can continue to release venom even after the initial sting. Once removed, pain and swelling may be reduced by using a cool compress or ice packs to the area. Always place a barrier between the skin and the ice cube to prevent burning. Topical 1 percent hydrocortisone cream or calamine lotion may be useful to ease redness, itching and swelling.
It is important not to scratch the lesion as this can cause skin breakdown and lead to possible infection. When itching is extremely bothersome, an antihistamine such as diphenhydramine (Benadryl) may be helpful. Speak with your doctor about dosage recommendations for children under 6.
For patients with anaphylaxis, immediate medical attention is necessary. Treatment often includes epinephrine, antihistamines and corticosteroids. In the future, it is important for these patients to carry epinephrine (in the form of an auto-injector) as this reaction can be life-threatening. All caregivers of children with anaphylactic reactions should be familiar with their treatment. Depending on the reaction, your child’s doctor may discuss allergy shots to reduce sensitization to bee stings with you.
Insect Bite Reactions
Insect bites are also common this time of year. Often, insect bites can go unnoticed at the time of attack, but are later noticed because of the irritation that ensues. The most common reaction is local redness, itching and swelling at the site of bite.
Insect bites should be washed with soap and water. Cool compresses and ice packs help to reduce the swelling. Antihistamines may be used for bothersome itching as well as topical ointments such as hydrocortisone cream and calamine lotion.
Anaphylaxis is rare with insect bites but has been noted to occur.
Repellants prevent attacks from biting insects (mosquitoes, ticks, fleas) but not stinging insects (bees). There are multiple repellants with varying effectiveness.
Products containing DEET such as OFF are extremely effective against biting insects and can last three-eight hours. These products should not be used in children under 2 months.
Permethrin containing products are best applied to clothing or bedding, and not to the skin. This compound is toxic to insects, but is thought to pose little danger to humans.
Repellants made with essential oils such as citronella, cedar, eucalyptus, and soybeans are generally much less effective.
Always read the labels of repellants carefully. Repellants should be applied to exposed skin only in a well-ventilated space. Do not use over wounds, inflamed or irritated skin. Wash your child’s skin with soap and water upon returning indoors.
When to See the Doctor
• Severe systemic reactions (anaphylaxis), regardless of whether epinephrine is given at the scene.
• If stung by insect known to have caused anaphylaxis previously, even if there is no evidence of a current allergic reaction.
• Severe itching not relieved by home treatments mentioned above.
• Evidence of infection such as fever, increasing pain, swelling, redness and drainage of pus at the sting site.
Dr. Shareef is a pediatric resident at Levine Children’s Hospital and Dr. Stubbs is a general pediatrician at Myers Park Pediatrics and Levine Children’s Hospital.