Treatment of bumblebee stings and allergies

Treatment of bumblebee stings and allergies

This information on bumblebee stings provides guidance for reducing the chance of being stung by a bumblebee. It also informs about the possible reaction to a sting and treatment. The poster version of Bumblebee stings and allergies can be downloaded here.

Bumblebee, honeybee, and wasp stings

Bumblebees are found  naturally in many countries. In addition, bumblebees and honeybees are used as pollinators in agricultural and horticultural crops. There are various subspecies with differing appearances, including different colors and patterns. In general, bumblebees are larger than honeybees and hairier than wasps.

Only bumblebee workers, which are the female bumblebees, and queens have stingers. This is also true with honeybees and wasps. Drones, which are the male bumblebees, cannot sting. Further, the stinger is mainly used as a weapon for defense. When a bee stings, some venom is injected into the body through the stinger. In humans, this generates a short severe pain that then eventually fades away. Occasionally (in approximately 1% of cases), an allergic reaction against the injected venom can develop. The response to a bumblebee sting can differ per incident, and per person.

The stinger of a bumblebee or a wasp has no barbs. This means that the worker and queen can withdraw their stinger and are able to sting again. Honeybees do have a barbed stinger, meaning they can only sting once. When a honeybee tries to withdraw its stinger, it tears loose from the abdomen, taking the venom gland with it.

How to prevent bumblebee stings?

Bumblebees rarely sting. The chance of being stung by a bumblebee can be reduced by avoiding provoking them or making them aggressive. First, it is important to be calm when working with bumblebees. Do not wave your arms at the bumblebees, bump the hive, touch or hold the bumblebees, etc.

Also, be aware that bumblebees can react aggressively to smells such as alcohol, perspiration, perfumes, scented soaps, aftershave, and so on. Moreover, rings, bracelets and watches may cause aggressive behavior (due to the scent of oxidized material between the skin and the jewelry). Bumblebees are attracted to the color blue, this includes blue colored clothing. Wearing protective clothing can reduce the risk of stings, such as gloves, hats, or thick shirts and pants. Nonetheless, bumblebees can still sting through most clothing.

Stung? Reactions and treatments

Usually a bumblebee sting leads to a non-allergic, local reaction: swelling, itchiness and redness at the site of the sting. This may last for only a couple of hours. Further, the reaction can occur directly after the sting, but more generally it starts after a few hours. The swelling or itching may last for hours or even days. In some cases, the local reaction may spread somewhat; in this case it usually takes longer for the symptoms to disappear. This still counts as a local, non-allergic reaction.

Treatment of a non-allergic, local reaction

Usually medical treatment is not necessary. Some measures can be taken to minimize the local reaction, especially in instances where a person has been stung in a sensitive location, such as near the eyes. As soon as possible after being stung, the person should take an anti-inflammatory (such as aspirin or ibuprofen) and place a cold compress to the site. In addition, many anti-itch ointments are available (e.g. containing diethyl-m-toluamide) which help to reduce symptoms.

In the rare case of a sting in the mouth or near the throat, specifically the pharynx, the patient should be taken to the hospital immediately; since the sting can result in blocked airways. At the hospital, the patient will be given corticosteroids (such as prednisone) and will be kept for observation.

Allergic reaction

In about 1% of the population, repeated stings may lead to an allergic reaction, also called a general allergic reaction, a systemic allergic reaction, or an anaphylactic reaction. Because an allergic reaction involves antibodies formed during a previous exposure to an antigen, it is not possible to have an allergic reaction after the first sting. Allergic reactions usually become evident very soon after the sting (from a few seconds to half an hour after the sting).

Allergic reactions are classified in four levels; in order of increasing severity:
Level 1 - itching, redness, swelling, urticaria, and/or hives over the whole body
Level 2 - level 1 symptoms plus intestinal problems (vomiting, diarrhea)
Level 3 - level 1 and/or 2 symptoms plus difficulties in breathing and/or a feeling of suffocating
Level 4 - level 1 and/or 2 and/or 3 symptoms plus heart palpitations, fainting, anaphylactic shock (accompanied by dizziness, excessive sweating, and cold shivers)

Treating an allergic reaction

In the event of a fever occurring or a Level 1 reaction, contact a medical provider. The medical provider may choose to keep an eye on the situation and see how things go. A period of observation in hospital is desirable, as the reaction may increase progressively over time.

Additionally, if a medical provider cannot be reached call the Poison Control Center at 1-800-222-1222.

In the event of vomiting and in the case of Level 3 or 4 symptoms, the victim should be taken to a hospital immediately. If an allergic reaction occurs, administration of a prescription-strength antihistamine (such as clemastine) is useful. The antihistamine reduces the swelling caused by the histamine in the venom. In some cases, corticosteroids (such as DAF/Dexamethasone) are prescribed. In the case of Level 3 or 4 reactions, it is necessary to administer adrenaline first. Adrenaline stimulates the heart, constricts the blood vessels and opens the airways. Furthermore, adrenaline can be self-administered by means of an adrenaline auto-injector, such as an EpiPen or Jext. Adrenaline auto-injectors are only available by prescription, for instance if the patient has already had an allergic reaction to a bumblebee sting. Depending on local legislation, an adrenaline auto-injector may also be available at companies which work with bumblebees.

Toxic reactions

Toxic reactions only occur when the victim is stung dozens of times in a brief period. General allergic reactions can occur in the nervous or circulatory system, such as cardiac arrhythmia or difficulties with breathing. In this case as well, the victim should be taken to a hospital for treatment and observation immediately.

Hyperventilation

In addition to a severe Level 4 allergic reaction hyperventilation, perhaps because of shock, may also cause loss of consciousness. In such cases it is also necessary to call the emergency medical services immediately.

Increased risk

People who use certain medicines (beta-blockers) and pregnant women are at increased risk when allergic reactions occur after a bumblebee sting.

Living with a bumblebee allergy

If you have had an allergic reaction previously, you will not necessarily have an allergic reaction to the next sting. Therefore, if you had a Level 1 or 2 reaction, the chance of an allergic reaction again is small. Reactions to bumblebee stings may differ in each case. It is now possible to take a test using purified bumblebee venom to determine whether you will have an allergic reaction the next time you are stung. It is also possible to use the purified venom for a hyposensitization treatment. This treatment is intended to desensitize the body to bumblebee venom.

Immunotherapy with honeybee venom does not necessarily protect patients with a bumblebee allergy. If you do not wish to undergo hyposensitization treatment, you can obtain a prescription for an adrenaline auto-injector, such as an EpiPen or Jext from your doctor. This can be carried with you and is used to inject epinephrine into the thigh in the case of a sting. Tests and treatments are available; contact your medical provider for a list of specific locations.

Information for doctors

Detailed information regarding medical treatment of allergic reactions is available from Koppert on request.
For further information, contact an allergologist or a doctor of internal medicine.

Literature
De Groot, H. Allergie voor insecten, Huisarts en Wetenschap 2002; 45 (7): 362-7.
De Groot, H. Allergy to bumble bees. Curr Opin Allergy Clin Immunol 2006; 6: 294-7.

A printed poster showing the images is available from Koppert. This poster is also available as a download (URL).

Tip: Add the contact information for seeking medical assistance and emergency medical treatment on the poster.

This information is intended as an education resource only and should not be used for diagnosing or treating a health problem as it is not a substitute for medical care. If you have or suspect you may have a health problem, please consult medical care.

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