Hymenoptera (Bee, Wasp, Hornet) Envenomation

Presentation

Sometimes a patient comes to a hospital emergency department (ED) or urgent care center immediately after a painful sting because of alarm at the intensity of the pain or worry about developing a serious, life-threatening reaction. Sometimes the patient seeks help the next day because of swelling, redness, and itching. Parents may not be aware that their child was stung by a bee and may be concerned only about the local swelling.

The usual local reaction to a hymenopteran sting is immediate burning pain, followed by an intense local erythematous wheal, which usually subsides within several hours. Often there is a central punctate discoloration at the site of the sting or, uncommonly, a stinger may be protruding (only honeybees leave a stinger).

A more extensive delayed hypersensitivity reaction can occur , producing varying degrees of edema and induration, which can be quite dramatic when present on the face and may involve all of an arm or leg ( Fig. 173.1 ). These local hypersensitivity reactions can last as long as 7 days. Tenderness and (occasionally) ascending lymphangitis can occur.

Symptoms of a severe anaphylactic reaction may include generalized urticaria, angioedema, generalized pruritus, shortness of breath, chest constriction, wheezing, stomach pain, nausea, vomiting, dizziness, hoarseness, thickened speech, inspiratory stridor, weakness, confusion, and feelings of impending doom or even loss of consciousness.