Bee, Wasp & Hornet Sting First Aid: When to Call 911 & Treatment Steps

Call 911 / Go to ER Immediately If:

• Known severe allergy (anaphylaxis history) – **use epinephrine FIRST, then call**
• Stung in mouth, throat, or tongue (airway swelling risk)
• Multiple stings (>5 in children, >10–20 in adults, or >50 any age)
• Signs of anaphylaxis (see below)
• Stinger cannot be removed (rare)

Anaphylaxis Signs – Act FAST

• Difficulty breathing, wheezing, throat tightness
• Swelling of lips, tongue, face, throat
• Hives, flushing, itching (widespread)
• Nausea, vomiting, abdominal cramps, diarrhea
• Dizziness, fainting, hypotension
• Sense of doom, confusion

Epinephrine auto-injector (EpiPen, Auvi-Q, generic) FIRST, then 911. Second dose in 5–15 min if no improvement.

Standard First Aid (Non-Allergic, Single Sting)

1. Remove stinger IMMEDIATELY: Scrape sideways with credit card/fingernail. **Do NOT pinch/tweeze** – squeezes venom sac.
2. Wash: Soap and water.
3. Cold compress: Ice pack wrapped in cloth, 10 min on/off.
4. Elevate if on extremity.
5. Pain/itch relief:
   • OTC: Ibuprofen (Advil) or acetaminophen (Tylenol)
   • Topical: Hydrocortisone 1% cream, calamine lotion, baking soda paste
   • Oral antihistamine: Cetirizine (Zyrtec), loratadine (Claritin), diphenhydramine (Benadryl – sedating)
6. Monitor for 30–60 min for delayed reaction.

Bee vs. Wasp vs. Hornet Differences

Prevention

• Avoid bright colors, floral prints, sweet scents outdoors.
• Cover food/drinks; check cans/straws.
• Don't swat – move calmly away.
• Professional nest removal for near-home nests.
• Carry epinephrine if allergic; wear medical alert.

Most stings are painful but harmless. Anaphylaxis is rare (~3% adults, <1% kids) but life-threatening. When in doubt, seek care.

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Insect	Stinger	Aggression	Venom
Honey bee	Barbed – stays in, bee dies	Defensive only	Acidic; melittin
Bumble bee	Smooth – can sting repeatedly	Docile	Similar
Wasp (yellow jacket, paper wasp)	Smooth – multiple stings	Aggressive, scavengers	Alkaline; different allergens
Hornet (larger wasp)	Smooth – multiple stings	Very aggressive near nest	High acetylcholine → more pain