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]

  This can lead to very large swelling around the sting site or in a whole portion of the body. The area is quite likely to itch. Oral and topical antihistamines should help prevent or reduce the itching and swelling. [web.archive.org]

• 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]

• Periodontitis

  This paper reports a case of bee sting in the right floor of the nose that mimicked an odontogenic infection affecting the upper lip, canine space and nasal cavity such as in cases of infection secondary to pulpal or periodontal pathology of the anterior [ncbi.nlm.nih.gov]

• Corneal Infiltrate

  Ocular bee stings are known to cause corneal melts, corneal infiltrates, cataracts, and secondary glaucoma. Our patient presented with scleritis, corneal infiltrates, and endophthalmitis after a ocular bee sting. [ncbi.nlm.nih.gov]

• Heterochromia Iridis

  Corneal epithelial defect, corneal edema, secondary bacterial keratitis, heterochromia iridis, and internal ophthalmoplegia were identified The corneal edema markedly improved 3 days after removing the retained bee stingers and treatment by topical antibiotics [ncbi.nlm.nih.gov]

• Conjunctival Hyperemia

  The right eye showed edema of the upper and lower eyelid, conjunctival hyperemia, chemosis, and striate keratitis of the paracentral cornea by biomicroscopic examination. The stinger was identified in the depth of the corneal infiltration. [ncbi.nlm.nih.gov]

• Urticaria

  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]

  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]

  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]

  Reactions to insect bites, including bee stings, clinically show mild symptoms such as skin problems, urticaria (hives) and pain. It can also cause respiratory failure, kidney damage, and hemorrhaging [ 10, 11 ]. [selfhacked.com]

• Photosensitivity

  A 57-year-old male beekeeper was evaluated for pain, blurry vision, and photosensitivity after a corneal bee sting. Of note, the venom sac had been removed with dirty tweezers three days prior to his visit. [ncbi.nlm.nih.gov]

• Palpable Purpura

  Henoch Schonlein purpura (HSP) is a common childhood vasculitis, characterized by a non-thrombocytopenic palpable purpura and systemic features. It can be triggered by conditions like infections and insect bites. [ncbi.nlm.nih.gov]

• Neurologic Manifestation

  Hymenoptera stings lead to a myriad of neurologic manifestations by the mechanism of immediate or delayed hypersensitivity reactions. The more common form of polyneuropathy associated with these stings is the acute inflammatory demyelinating type. [ncbi.nlm.nih.gov]

  The review regarding various neurological manifestations revealed that several syndromes, presumed to be immune-mediated, are associated with late complications of Hymenoptera envenomation, including Guillain-Barre syndrome, multiple sclerosis, optic [ajns.paans.org]

• Focal Neurological Deficit

  A 60-year-old man developed a focal neurologic deficit 2 hours after multiple bee stings, which was confirmed to be acute cerebral infarctions on magnetic resonance imaging scan. [ncbi.nlm.nih.gov]

• Generalized Tonic-Clonic Seizure

  A 49-year-old male patient was brought to the emergency department because of generalized tonic clonic seizure and loss of consciousness after an hour of wild bee bite from the anterior abdomen in a rural area. [ncbi.nlm.nih.gov]

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.

• ST Elevation

  We described here a patient envenomated by a bee sting that caused myocardial damage compatible with non-ST elevation acute myocardial infarction. [ncbi.nlm.nih.gov]

• Electrocardiogram Change

  The patient developed a typical course of myocardial infarction, but the electrocardiogram changes were reversed to almost normal limits. He had a nonsignificant mild lesion in the proximal port of right coronary artery in coronary angiography. [ncbi.nlm.nih.gov]

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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