OVERVIEW

What is a bee sting?

A bee sting occurs when the venomous stinger of a bee penetrates the skin and injects various bioactive compounds and antigenic substances into the body. Mild cases may cause local reactions, while severe cases can trigger immune responses due to these antigens entering the body, leading to systemic symptoms.

Common types of bee stings include honeybee stings, wasp stings, and stings from swarms of bees.

SYMPTOMS

What are the local manifestations of a bee sting?

The severity of symptoms after a bee sting depends on the amount of venom, the site of injection, individual sensitivity, and physiological and psychological state. After being stung by a few bees, localized redness, swelling, pain, and itching may occur, with a few cases developing blisters or skin necrosis. If only local reactions are present, no treatment is needed as symptoms typically resolve on their own within hours.

Some patients may retain venomous stingers, which can lead to secondary bacterial infections or suppuration. Stings in special areas (e.g., eyes, mouth) may cause severe consequences.

What systemic symptoms may occur after a bee sting?

Systemic symptoms from bee stings are generally mild, but multiple stings from a swarm can cause severe reactions, including rapid-onset systemic allergic reactions such as:

• Skin manifestations (widespread erythema, itching, urticaria);
• Digestive symptoms (abdominal discomfort, pain, nausea, vomiting);
• Angioedema (throat swelling, upper airway obstruction);
• Respiratory symptoms (dyspnea, bronchospasm);
• Circulatory symptoms (hypotension, shock, or even cardiac arrest).

What other harm can bee stings cause to the body?

Bee venom is a biotoxin containing formic acid, various bioactive mediators, and antigenic substances.

Honeybee venom is acidic and contains histamine, neurotoxins, hemolysins, and mast cell degranulating peptides. A single sting rarely causes systemic symptoms, with only mild local reactions requiring no special treatment. Wasp venom is alkaline and more toxic, containing serotonin, bradykinin, cholinesterase, and hyaluronidase in addition to histamine.

Multiple stings from bees or wasps can induce systemic symptoms. Severe cases may involve rhabdomyolysis, leading to acute kidney failure, liver damage, shock, or hemolysis.

Phospholipases and hyaluronidases act as potent allergens, triggering severe allergic reactions. Venom-allergic individuals may experience anaphylactic shock after a sting, requiring emergency treatment. Mass envenomation is a critical condition with rapid progression and high mortality, often fatal within days if untreated.

CAUSES

What is the cause of bee stings?

As the name suggests, the cause of bee stings is accidental attacks by bees, including both single bee stings and swarms of bee stings.

DIAGNOSIS

How to Diagnose a Bee Sting?

Diagnosis of a bee sting should be based on medical history + symptoms + signs. The patient must have a history of being stung by a bee or wasp, with clinical manifestations including localized pain, itching, and systemic toxic symptoms such as fever, headache, vomiting, abdominal pain, and irritability.

Patients allergic to bee venom may experience allergic reactions such as chest tightness, difficulty breathing, facial flushing, and widespread rashes. Some patients may have visible stingers at the site of the wound. Localized swelling and redness are common, with a few cases showing blisters or skin necrosis. Severe cases may present with muscle spasms or coma.

What Tests Should Be Done for Bee Sting Patients?

• Severe systemic reactions or allergic reactions may lead to acute kidney failure. Tests such as transaminase, total bilirubin (TBIL), BUN, Cr levels, and liver function tests should be performed to monitor liver function.

• Multiple organ dysfunction may occur, requiring monitoring of liver and kidney function, cardiovascular function, etc.

• Severe bee stings may affect blood cell counts and coagulation function. Complete blood count (CBC) and coagulation tests should be conducted to measure white blood cells (WBC), troponin, myoglobin, prothrombin time (PT), activated partial thromboplastin time (APTT), etc.

• Sometimes, cardiac enzyme tests are needed to monitor myocardial function.

Timely and accurate laboratory tests help assess the extent and severity of organ damage, providing a basis for prompt and effective treatment.

What Other Conditions Should Bee Stings Be Distinguished From?

This condition can usually be diagnosed based on medical history alone, without requiring special differentiation. Occasionally, it may need to be distinguished from other venomous stings, but a detailed history can confirm the diagnosis. Allergic urticaria caused by bee stings may need to be differentiated from urticaria due to other causes, which can also be clarified through a thorough medical history.

When Should a Bee Sting Patient Seek Medical Attention?

After being stung, the stinger should be removed as soon as possible. If there are no obvious discomforts, rest and observe for a few hours. Seek medical attention immediately if any of the following occurs:

• If there is significant skin redness, swelling, or pain, visit a dermatology department.

• If allergic symptoms such as nausea, dizziness, or multiple stings occur, or early signs of allergic reactions (e.g., chest tightness, difficulty breathing, facial flushing, widespread hives) appear, seek emergency anti-allergy treatment immediately to prevent anaphylactic shock or fatal airway obstruction due to laryngeal edema.

• Patients with severe systemic reactions, unstable vital signs, or organ dysfunction should be hospitalized as soon as possible.

TREATMENT

Is There a Risk of Death After a Bee Sting?

Typically, a single bee sting rarely causes systemic symptoms, presenting only mild local reactions that require no special treatment. However, some individuals highly sensitive to bee venom may experience immediate hypersensitivity reactions after being stung by just one bee, manifesting as diffuse urticaria, laryngeal edema, asthma, or even bronchospasm. In severe cases, anaphylactic shock or suffocation can lead to death.

How Should Non-Allergic Individuals or Those with Only Local Reactions Treat Bee Stings?

For people who are not allergic to bee venom, stings from a few bees usually cause only local reactions, so local treatment is sufficient.

• Immediately remove the stinger using sticky tape or carefully extract it with a needle or blade. Avoid squeezing the sting site to prevent residual venom from being released, which could worsen the reaction.

• Bee venom is acidic, so applying concentrated soapy water or diluted baking soda solution can help neutralize the acidic venom.

• Wasp venom is weakly alkaline. Local application of vinegar, acetic acid, or other acidic solutions can help cleanse the wound. Alternatively, rinse thoroughly with clean water. Topical application of Jidesheng snake medicine or ice packs can also reduce local reactions.

How Should Allergic Individuals or Those with Severe Systemic Reactions Treat Bee Stings?

Stings from venomous bees (e.g., hornets) or swarms, or systemic allergic reactions to bee venom, require emergency anti-allergy treatment:

• Severe allergic reactions should be treated immediately with 0.1% epinephrine (0.3–0.5 mg for adults, 0.01 mg/kg for children, not exceeding 0.3 mg) via subcutaneous or intramuscular injection. If ineffective or if circulatory failure occurs, intravenous administration is necessary.

• Antihistamines;

• Corticosteroids;

Additionally, maintaining vital organ function and providing supportive care are essential. Treatments such as blood purification (hemodialysis combined with hemoperfusion) or plasma exchange may be considered for severe cases to remove toxins bound to plasma proteins.

What Other Conditions Can Bee Stings Cause?

• Some patients with severe systemic symptoms may develop acute hemolysis or acute kidney injury early after admission, presenting with dark urine, hematuria, or oliguria.

• If systemic reactions are not effectively controlled, widespread damage to organs such as the liver, kidneys, coagulation system, and myocardium may occur, potentially leading to multiple organ dysfunction syndrome (MODS).

• Untreated allergic reactions to bee venom can result in anaphylactic shock and death.

DIET & LIFESTYLE

What should be noted in daily life after a bee sting?

• After being stung, adjust your mindset—neither be overly careless nor excessively anxious or fearful.

• Maintain a light diet, avoid spicy and irritating foods, drink plenty of water, and keep bowel movements regular to aid detoxification.

• For skin care, pay attention to personal hygiene and keep the skin clean and dry.

• Avoid scratching or squeezing the affected area to reduce bleeding or infection.

PREVENTION

How to Determine the Prognosis of a Bee Sting?

The prognosis depends on the species and number of venomous bees, the number of affected organs, and the severity of damage. Generally, if local reactions disappear within a few hours after a bee sting, the prognosis is favorable.

• If a patient is stung by wasps or a swarm of bees and subsequently develops allergic symptoms such as diffuse rashes, abnormal respiratory rhythms, or throat discomfort, delayed treatment often leads to a poor prognosis.

• Individuals attacked by a swarm or those allergic to bee venom should promptly prevent and treat multiple organ failure to avoid worsening systemic reactions, which may cause liver and kidney damage, as well as affect the nervous and cardiovascular systems, ultimately leading to cardiac or respiratory paralysis and death.

• Early anti-allergy treatment can improve the patient's prognosis. Untimely management of allergic reactions may result in fatal conditions such as laryngeal edema.

How to Avoid Bee Stings?

• Summer and autumn are seasons with high wasp activity, often in areas with dense wild vegetation. When traveling to the countryside or working outdoors, wear long sleeves and pants.

• Avoid placing beverages, alcohol, or cosmetics near bee swarms to prevent attracting wasps.

• If encountering a swarm of bees, retreat quickly and avoid swatting or provoking them.

• If attacked by wasps, do not run or swat. Instead, lie flat on the ground and cover your entire body, especially your head and face, with clothing.

• If a wasp lands on your limb, gently shake it off instead of swatting to avoid provoking an attack.

• Non-professionals should not disturb beehives. If wasp nests are found nearby or under eaves, seek assistance from relevant authorities for removal.