📋 Steps
1
Remove the stinger immediately if present
Bees (honey bees) leave a stinger with venom sac attached. Remove it by scraping sideways with a fingernail, credit card edge, or flat object within seconds — every second of continued venom injection increases the reaction. Wasps and hornets don't leave stingers.
2
Clean the sting site and apply ice
Wash the sting area with soap and water. Apply a cold pack or ice wrapped in cloth for 10-15 minutes to reduce pain and swelling. Repeat every few hours as needed. Elevate the stung limb if possible.
3
Take oral antihistamine for itching and local swelling
Diphenhydramine (Benadryl) 25-50mg or loratadine (Claritin) 10mg reduces local swelling, itching, and normal histamine response. Oral antihistamines do NOT prevent or treat anaphylaxis — they're for comfort management of normal reactions only.
4
Monitor for anaphylaxis signs for 30 minutes
Normal reaction: increasing pain and local swelling for 24-48 hours, then gradual resolution. Anaphylaxis warning signs (any of these = call 911 immediately): hives or itching beyond the sting site, swelling of lips or tongue, difficulty breathing or swallowing, tightness in chest, dizziness, nausea, or loss of consciousness. These signs typically develop within 15-30 minutes.
5
If EpiPen is available and anaphylaxis is occurring — use it
For people with known sting allergy and an EpiPen: use it at the first sign of systemic reaction (hives spreading beyond sting site, throat tightness). Administer to the outer thigh, call 911 immediately after, and get to an ER — EpiPen buys time, not resolution. A second EpiPen may be needed if available.
💡 Tips
- Large local reactions — a sting that swells the entire forearm — look alarming but are not anaphylaxis; they're a normal (if exaggerated) local reaction that doesn't indicate systemic risk
- If you've previously had anaphylaxis from a sting, talk to your doctor about venom immunotherapy (allergy shots) — it's 95%+ effective at preventing future anaphylaxis
- Calling 911 for a normal sting reaction that involves only local pain and swelling is generally not warranted; calling for any systemic symptom is appropriate even if you're unsure
- Children under 5 and adults over 65 have higher anaphylaxis risk from stings — any signs of distress in these groups after a sting warrant physician evaluation
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