Common Insect Bites and Stings: Identification, Risks, and First Aid

Quick reference for frequent biters/stingers in North America:

When to Seek Care

• Signs of anaphylaxis: throat swelling, wheezing, hypotension, widespread hives
• Expanding erythema, fever, red streaks (cellulitis)
• Bull’s-eye rash (Lyme), necrotic ulcer (recluse)
• Neurologic symptoms after bite

Prevention: EPA-registered repellents, permethrin-treated clothing, tick checks, screens, pet treatment.

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Insect	Appearance / Sensation	Key Risks	First Aid
Fire ant	Burning sting → pustule at 24 hrs	Anaphylaxis, secondary infection	Cold compress, antihistamine, avoid scratching
Bee / Wasp / Hornet	Immediate sharp pain, welt	Anaphylaxis (bee), multiple stings → toxicity	Remove stinger (scrape), ice, epinephrine if allergic
Mosquito	Itchy wheal	West Nile, Zika, dengue, malaria (travel), EEE	Anti-itch cream, repellent (DEET/picaridin)
Flea	Small grouped papules, ankles	Typhus (rare), tapeworm (ingestion), allergy	Treat pets, vacuum, topical anti-itch
Bed bug	Linear clusters, nocturnal	Insomnia, anxiety, secondary infection	Professional extermination, antihistamines
Tick	Attached, painless	Lyme, RMSF, anaplasmosis, babesiosis, alpha-gal	Remove with tweezers (steady pull), save tick, monitor 30 d
Spider (widow/recluse)	Variable; widow: cramps, diaphoresis; recluse: necrotic ulcer	Systemic envenomation (widow), necrosis (recluse)	Ice, elevate, seek ER for systemic signs/necrosis