Bee Sting Swelling: Identifying Normal vs. Dangerous Reactions and When to Seek Emergency Care

Most bee stings cause local reactions: immediate pain, redness, swelling (up to a few cm), and itching resolving in hours to days. However, some reactions signal medical emergency.

Normal Local Reaction

• Pain, redness, swelling < 5 cm diameter.
• Peaks at 24–48 hours, resolves in 3–5 days.
• Managed with ice, elevation, OTC antihistamine, NSAID.

Large Local Reaction (LLR)

• Swelling > 10 cm, often crossing joints.
• Peaks at 48–72 hours, lasts 5–10 days.
• Not allergic; risk of anaphylaxis with future stings is only 5–10%.
• May need oral corticosteroids (prednisone) if severe.

Systemic Allergic Reaction (Anaphylaxis) – CALL 911

• Difficulty breathing, wheezing, stridor.
• Swelling of lips, tongue, throat, uvula (angioedema).
• Hives, flushing, itching beyond sting site.
• Nausea, vomiting, diarrhea, abdominal cramps.
• Dizziness, fainting, hypotension.
• Rapid, weak pulse.
• Sense of impending doom.

When to Seek Medical Care

• Any anaphylaxis symptom → Epinephrine auto-injector (EpiPen) IMMEDIATELY, then 911.
• Sting in mouth/throat → ER (airway risk).
• Multiple stings (>10 in adults, >5 in children) → toxic envenomation risk.
• Signs of infection (increasing redness, warmth, pus, red streaks, fever) after 24–48 hrs.
• LLR not improving after 5–7 days or worsening.
• History of severe reaction → see allergist for venom immunotherapy (97% effective).

Carry epinephrine if prescribed. Wear medical alert ID.