The signs and symptoms can range from mild and moderate to severe. Local features include pain, bleeding and discharge from the sting site along with redness and elevated temperature. Allergic findings include red rash, pruritus or itching, urticarial and marked angioedema.

General symptoms such as nausea and vomiting, fever, weakness and dizziness may also be present. In some cases, confusion, delirium, anxiety and even convulsions may be seen.

Cardiac and respiratory features include chest pain, syncope, tachypnea, hypotension, wheezing, laryngospasm, bronchospasm and respiratory arrest [1] [2] [3]. In serious cases, even myocardial infarction may result [4] [5]. In some cases, shock and ultimately death may occur [6] [7].

Blood and serum tests are usually performed to monitor the white blood count of the individual and to assess the degree of allergic reaction [8]. Mast cells and IgE levels within the body are an indicative of the degree of allergy.

First aid

• Immediate first aid treatment should be given to the patient even before hospitalization [9].
• The patient’s airway should be immediately cleared. Artificial breathing should be given if necessary.
• The stinger, if still present at the site of sting, should be carefully removed with any sharp tipped object.
• Calamine lotion is helpful in cases of mild itching and inflammation.

Medical treatment

The medical management of the patients of bee sting consist of the following measures.

• Hemostatic drugs and vasoconstrictors like epinephrine should be administered. However, if the patient is in respiratory distress, the use of these drugs should be avoided.
• The affected area should be raised to avoid the development of edema.
• Cold packs should be applied for reducing inflammation.
• Hydrocortisone should be applied to the affected area topically to reduce the severity of immune response.
• Antihistamines can also help prevent immune response. They can also help with respiratory distress [10].
• Analgesics should be administered for alleviating the pain.

Surgical indications

Most of the stings do not need any further medical treatment. However, in case of symptoms of shock and/or respiratory distress, patient should be immediately hospitalized and be treated accordingly.

Tracheostomy is done in case of laryngeal edema. Intravenous line is maintained and saline is given to stabilize the blood pressure of the individual. Continuous monitoring for vitals is done.

Advice at disharge

At the time of discharge of the patients predisposed to extreme anaphylaxis and allergic reactions, it is recommended to advice the patient to carry epinephrine in any self-injectable form (such as EpiPen, Emerade, Twinject, Adrenaclick) so that life threatening anaphylaxis in the future can be promptly managed.

Allergic desensitization therapy can also be advised to such patients which may provide life long protecting against the allergy caused by bee (and other insect) stings.

Most of the cases of bee sting result in mild to moderate manifestation of the symptoms. With proper care, they can recover completely. However, in case of severe allergic reaction (anaphylaxis) or in case the patient is not immediately given medical help, it can prove to be fatal.

Disturbing the natural habitation of the bees can trigger their defenses leading to an attack. Usually, the bees stack together; whole body may be affected by bees’ stings. Swallowing of bees may also occur in case of a violent attack. The signs and symptoms of solitary bee stings are mostly localized, hardly evoking any systemic reaction.

The ovipositor, the stinging organ of bees punctures the skin of the victims and venom is injected into the body through the ovipositor.

Not all the patients who suffer from bee stings develop severe clinical features that require hospital management. Around the world, only around 3% of those stung by bees develop signs and symptoms of an allergic reaction. About 0.8 % of the children and about 3 % of the adult victims develop anaphylaxis. The mortality rate of anaphylaxis as a result of a bee sting is 1 to 5 % in various countries of the world.

No racial, gender or age predilection exists in cases of bee sting. However, people who live in rural and floral areas are naturally at an increased risk for being stung by bees.

Insertion of bee venom causes localized allergic reaction at first. Local capillary permeability is increased, causing leakage of serum from the blood vessels. Leukocytes are recruited next, that release inflammatory cytokines, particularly interleukins. They attract the mast cells and basophils. These interleukins cause chemotaxis of mediators of inflammation towards the site of bee sting. A flare is formed at the site of sting. IgE-mediated immune response occurs in the victim.

The following measures are effective in safekeeping oneself from bee stings.

• Avoiding going too near bee hives and disturbing them.
• While going near bee hives, heavy perfumes and floral patterned garments should be avoided to prevent the bees from getting attracted.
• Wearing closed shoes while going out.
• While removing the stinger, it should not be squeezed to avoid injecting more venom. No tourniquet should be used as it may worsen the edema.
• Inspecting the homes and immediate surroundings regularly to keep hidden beehives in check.

Bee sting is the name given to the bit of a bee, whether it be a honey bee, a bumble bee or some other closely related species. Some of the bee stings can be really painful with rapidly developing symptoms; others can be relatively benign, with hardly any outward manifestation of a sting. 

Some people have severe allergic reaction to bee stings. Anaphylaxis may develop and it may even be fatal. Adequate and prompt medical therapy is recommended in order to prevent mortality in such patients. The patients who are prone to the development of allergic reaction to bee stings should be advised to carry an epinephrine autoinjector (eg. EpiPen, Emerade, Twinject, Adrenaclick) with them. Allergic desensitization therapy may also be helpful.

Bees attack on provocation, injecting their venom through pincers. This leads to eruption of red flare at the site of sting. Itchiness and bleeding may also occur. The patient may feel nauseous, dizzy, short of breath.

Immediate medical help should be sought to avoid fatal allergic complications. If the victim shows signs of difficulty in breathing or swallowing, swelling on face or neck area, dizziness, fits or blueness of the skin, he should be immediately taken to the hospital. With proper medical care, the signs can be easily reversed.

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