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].

• Swelling

  Anecdotal evidence from calls suggested it was effective in reducing the swelling and duration of pain, but a literature search found no evidence to support this. [ncbi.nlm.nih.gov]

  The bee sting may swell for 48 hours after the sting. The swelling can be small or large. Stings on the face can cause a lot of swelling around the eye. It looks bad, but this is not serious. The swelling may last for 7 days. Redness. [stlouischildrens.org]

• Collapse

  Unusually, manifestations like vomiting, diarrhea, dyspnea, generalized edema, acute renal failure, hypotension and collapse may occur. [ncbi.nlm.nih.gov]

  Reddening Itching (local reaction or whole body) Swelling Severe pain Hives Vomiting Heart palpitations Drop in blood pressure Circulatory collapse Fainting Respiratory arrest Those with allergies will have been given an emergency kit with drugs (antihistamines [helsana.ch]

  All bees are affected by CCD (Colony Collapse Disorder), not just honey bees. Colony Collapse Disorder (CCD) only affects honey bees in managed hives. Native bees are not affected by this disorder, but they do have their own problems to worry about. [web.archive.org]

  Without prompt treatment, this reaction can lead to circulatory collapse, loss of consciousness, shock, and death. What must you do immediately? Assess and support Ms. Davis's airway, breathing, and circulation as needed. [journals.lww.com]

• Fatigue

  Secondary outcomes were lesion load on T2*-weighted MRI, relapse rate, disability (Expanded Disability Status Scale, Multiple Sclerosis Functional Composite, Guy's Neurologic Disability Scale), fatigue (Abbreviated Fatigue Questionnaire, Fatigue Impact [ncbi.nlm.nih.gov]

  This drug has shown promising results for MS-associated fatigue, leg weakness, and walking difficulty. [neurologycare.net]

  After a bite, be sure to watch for signs such as fever, body aches, or fatigue. Although similar to signs of the flu, these symptoms can be far more serious when experienced after a suspicious bug bite. [mymdnow.com]

  Its clinical symptoms include loss of coordination, sensory impairment, cognitive dysfunction, and fatigue. [selfhacked.com]

  More than 1,300 people with MS have sent testimonials to the American Apitherapy Society in support of the treatment saying the therapy helped relieve fatigue and muscle spasm, as well as to restore stability. [encyclopedia.com]

• Chills

  Strain into a chilled cocktail glass. Garnish with lemon. [thekitchykitchen.com]

  When to see your doctor Call your doctor if you have been stung and have: swelling in your eyelids, lips or genitals signs of infection: increasing pain, redness, swelling, red streaks leading away from the sting, heat, discharge of pus, fever or chills [health.govt.nz]

  Symptoms can include: swelling redness drainage of pus fever pain malaise chills Trouble swallowing and breathing as well as swelling of the lymph vessels have also been associated with a bee sting infection. [healthline.com]

  Refrigerate until chilled through, at least 45 minutes and up to 3 hours. Slice with a serrated knife, and serve. [marthastewart.com]

• Crying

  While he was crying, I would look at him, hold him, and tell him I was keeping him safe. I didn’t know how much to push him, so we did this a little at a time. He finally got over his fears. [handinhandparenting.org]

  Not a minute later, my two-year-old son was crying because he had touched the bee and it had stung the end of his finger! I looked closely at the bee and saw it was still alive, though barely. Just alive enough to sting, apparently! [creativehomemaking.com]

• Muscle Strain

  After working a 12-hour day performing stunts for his new movie Geostorm, Gerard Butler relied on a controversial holistic treatment to release his muscle strain — and he ended up in the hospital. [refinery29.com]

• Urticaria

  Signs: Local Reactions Bees/Wasps ( Venom contains biogenic amines) Erythematous Papule s develop in seconds Most lesions subside in 4-6 hours Larger areas of edema and Urticaria may develop (10%, lesions may last >48 hours) Some extensive local reactions [fpnotebook.com]

  Davis's body produced multiple antibodies, creating a cascade of immune system reactions causing urticaria, pruritus, wheezing, and dyspnea. A person's first bee sting normally doesn't cause anaphylaxis. [journals.lww.com]

  After the live challenge, there was mild urticaria in a single patient; no SR developed in the rest of the patients. [ncbi.nlm.nih.gov]

  The clinical features are the same as anaphylaxis due to other causes, and include urticaria, flushing, angioedema, life threatening circulatory collapse and bronchospasm. It may be fatal. [dermnetnz.org]

• Fear

  Naturally, most people ponder stings with a mixture of fear and curiosity. In truth, bees are docile and hardworking by nature. Humans and bees can live together side-by-side quite pleasantly. [alveole.buzz]

  So I reread the Healing Children’s Fears booklet, and decided to try some of the ideas there, both Playlistening and Staylistening, to help him with this big fear. [handinhandparenting.org]

  But at a time when fears of antibiotic resistant super bugs are on the rise, this hidden trove of medicine could help doctors discover new treatments. [globalcitizen.org]

  People at risk for anaphylaxis often make substantial changes in their lifestyles and are fearful of subsequent exposure to insects.Over the past 15 years, our understanding of the natural history of allergy to insect stings has grown, purified venoms [doi.org]

  Fear of bee stings can sometimes result in people developing a fear of bees, which is known as apiphobia. It is a fact that an extreme reaction to bee stings can include anaphylaxis, which is a state of shock, but this is rare. [buzzaboutbees.net]

• Distractibility

  Perhaps it works - or perhaps just having something to do distracts you from the pain and makes you think that it works. Either way, it can't hurt ! [thecampingfamily.com]

  I would also add that rubbing a wound distracts the mind from the immediate pain and rubbing a wound with anything safe promotes the release of endorphins which may reduce the pain, if you believe something is going to work, then it often will because [insectstings.co.uk]

  During this time, the stinging bee will spend its dying moments distracting its victim by flying around its head as if it were going to sting again. [labs.biology.ucsd.edu]

  In addition to risk of side effects, and potentially distracting patients from mainstream therapy, there is also the more subtle psychological harm of being given false hope in a treatment that may not work. [sciencebasedmedicine.org]

• Irritability

  Hydrocortisone cream may also help to reduce the irritation of the sting. If there is any pain associated with the bite then a painkiller such as ibuprofen may be used. An ice pack may also help to reduce the swelling and irritation of a sting. [netdoctor.co.uk]

  Though your horse may not like this irritation, it is temporary and will not cause any permanent damage. [wagwalking.com]

  Take non-steroidal anti-inflammatory drugs (NSAIDs) with food or milk to prevent stomach irritation. [health.govt.nz]

  The majority of people will also have red, swollen and irritated skin in a diameter going out 2 or 3 inches from the location of the sting. Swelling can last about a week, and redness should subside after about three days. [choc.org]

• Confusion

  […] analysis of the proposed management by local medical practitioners and resident hospital staff members of three hypothetical bee-sting reactions has revealed that understanding of the use of adrenaline in patients with reactions to bee envenomation is confused [ncbi.nlm.nih.gov]

  However, if you run to a well-lit area, the bees will tend to become confused and fly to windows.Do not jump into water! The bees will wait for you to come up for air. [ars.usda.gov]

  These reactions include: breathing problems, swelling of lips and throat, swelling away from sting site, faintness, confusion, rapid heartbeat, hives, and nausea. [domyownpestcontrol.com]

  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. [symptoma.com]

  Call 911 Now Past severe allergic reaction to bee stings (not just hives) and stung less than 2 hours ago Wheezing or trouble breathing Hoarseness, cough or tightness in the throat or chest Trouble swallowing or drooling Speech is slurred Acts or talks confused [stlouischildrens.org]

• Headache

  Signs of allergic reaction include hives, headache, trouble breathing, tightness in the throat or chest, dizziness, nausea, or vomiting. [creativehomemaking.com]

  A few of these symptoms include, headache, fever, dizziness, fainting, nausea and vomiting. Bee Sting Prevention: Cover food and trash cans so bees will not be attracted to your living space. [go-forth.com]

  Common side effects include fast, irregular or “pounding” heartbeat, sweating, nausea or vomiting, breathing problems, paleness, dizziness, weakness, shakiness, headache, feelings of over excitement, nervousness or anxiety. [epipen.com]

  Multiple Bee Stings Symptoms: Nausea, vomiting or diarrhea Headache Vertigo Feeling faint or fainting Convulsions Fever Recovery Time: After medical treatment What it Means: When you get stung more than 12 times, the venom may produce a toxic reaction [terminix.com]

  Centers for Disease Control (CDC), spider bite symptoms may include: Raised welt with a pinpoint-sized dot in the center Pain, itching or rash Muscle pain or cramps Profuse sweating Headache Nausea or vomiting Chills and fever Allergic reactions In addition [livescience.com]

• Seizure

  We present and discuss the case that had epileptic seizures and SAH after a bee bite, with the review of the literature. [ncbi.nlm.nih.gov]

  But, the quantity of venom injected all at once could cause nausea, dizziness, faintness, and even seizures. All symptoms of an "ordinary" sting are at the sting site itself. Expected effects are pain, swelling, redness, and itching. [poison.org]

  Getting stung multiple times makes you more vulnerable to anaphylactic shock, and even seizures. Treat multiple stings like an emergency no matter what. You’ll also have to remove the stings with a greater sense of urgency. [beehivehero.com]

  […] and eyes Hoarseness and wheezing Dizziness and light-headedness Difficulty breathing Anxiety and disorientation Nausea and vomiting Symptoms of shock such as rapid heartbeat, weak pulse, pale skin and a drop in blood pressure Loss of consciousness or seizures [southerncross.co.nz]

  Continuous focal seizures were noted in the left upper limb. Deep tendon reflexes were normal so as the muscle tone. Owing to the mental status rest of the neurological examination was not performed. [ajns.paans.org]

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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3. Roslov LA. [Laryngeal edema caused by bee sting]. Vestnik otorinolaringologii. Sep-Oct 1958;20(5):116.
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5. Senthilkumaran S, David SS, Menezes RG, Thirumalaikolundusubramanian P. Acute myocardial infarction triggered by bee sting: an alternative view. Emergency medicine Australasia : EMA. Dec 2013;25(6):615.
6. Shvarts AI. [Death due to bee sting]. Sudebno-meditsinskaia ekspertiza. Oct-Dec 1966;9(4):50.
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9. Rubenstein HS. Bee-sting diseases: Who is at risk? What is the treatment? Lancet. Feb 27 1982;1(8270):496-499.
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