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Insect bites and stings

Definition

Insect bites and stings can cause an immediate skin reaction. The bite from fire ants and the sting from bees, wasps, and hornets are most often painful. Bites caused by mosquitoes, fleas, and mites are more likely to cause itching than pain.

Insect and spider bites cause more deaths from venom reactions than bites from snakes. Most deaths from insect bites are due to allergic reaction to the venom, rather than the toxins in the venom itself.

Alternative Names

Bee sting; Bed bug bite; Bites - insects, bees, and spiders; Black widow spider bite; Brown recluse bite; Flea bite; Honey bee or hornet sting; Lice bites; Mite bite; Scorpion bite; Spider bite; Wasp sting; Yellow jacket sting

Considerations

In most cases, bites and stings can be easily treated at home.

Some people have extreme reactions that require immediate treatment to prevent death.

Certain spider bites, such as the black widow or brown recluse, can cause serious illness or death. Most spider bites are harmless. If possible, bring the insect or spider that bit you with you when you go for treatment so it can be identified.

Symptoms

Symptoms depend on the type of bite or sting. They may include:

  • Pain
  • Redness
  • Swelling
  • Itching
  • Burning
  • Numbness
  • Tingling

Some people have severe, life-threatening reactions to bee stings or insect bites. This is called anaphylactic shock. This condition can occur very quickly and lead to rapid death if not treated quickly.

Symptoms of anaphylaxis can occur quickly and affect the whole body. They include:

  • Abdominal pain or vomiting
  • Chest pain
  • Difficulty swallowing
  • Difficulty breathing
  • Face or mouth swelling
  • Fainting or lightheadedness
  • Rash or skin flushing

First Aid

For severe reactions, first check the person's airways and breathing. If necessary, call 911 or the local emergency number and begin rescue breathing and CPR. Then, follow these steps:

  1. Reassure the person. Try to keep them calm.
  2. Remove nearby rings and constricting items because the affected area may swell.
  3. Use the person's EpiPen or other emergency kit, if they have one. (Some people who have serious insect reactions carry it with them.)
  4. If appropriate, treat the person for signs of shock. Remain with the person until medical help arrives.

General steps for most bites and stings:

Remove the stinger by scraping the back of a credit card or other straight-edged object across the stinger. Do not use tweezers -- these may squeeze the venom sac and increase the amount of venom released.

Wash the site thoroughly with soap and water. Then, follow these steps:

  1. Place ice (wrapped in a washcloth) on the site of the sting for 10 minutes and then off for 10 minutes. Repeat this process.
  2. If necessary, take an antihistamine or apply creams that reduce itching.
  3. Over the next several days, watch for signs of infection (such as increasing redness, swelling, or pain).

Do Not

Use the following precautions:

  • DO NOT apply a tourniquet.
  • DO NOT give the person stimulants, aspirin, or other pain medicine unless prescribed by a health care provider.

When to Contact a Medical Professional

Call 911 or your local emergency number if someone with a sting has the following symptoms:

  • Trouble breathing, wheezing, shortness of breath
  • Swelling anywhere on the face or in the mouth
  • Throat tightness or difficulty swallowing
  • Feeling weak
  • Turning blue

If you had a severe, bodywide reaction to a bee sting, your provider should send you to an allergist for skin testing and therapy. You should receive an emergency kit to carry with you wherever you go.

Prevention

You can help prevent insect bites and stings by doing the following:

  • Avoid perfumes and floral-patterned or dark clothing when walking through woods, fields or other areas which are known to have large number of bees or other insects.
  • Avoid rapid, jerky movements around insect hives or nests.
  • Do not put hands in nests or under rotted wood where insects may gather.
  • Use caution when eating outdoors, especially with sweetened beverages or in areas around garbage cans, which often attract bees.

Gallery

Bedbug - close-up
Bed bugs bites can leave a colorless welt along with an itching or burning sensation. (Image courtesy of the Centers for Disease Control and Prevention.)
Body louse
This is a magnified view of a body louse. Lice produce itching and a characteristic skin rash, which looks like a scrape. Lice may also carry organisms that cause relapsing fever, typhus, and trench fever. (Image courtesy of the Centers for Disease Control and Prevention.)
Body louse, female and larvae
This is a magnified view of a female body louse with larvae. Lice cause itching and a characteristic excoriated skin rash (looks like a scrape). They may also transmit diseases, including relapsing fever, typhus, and trench fever. (Image courtesy of the Centers for Disease Control and Prevention.)
Bedbug - close-up
Bed bugs bites can leave a colorless welt along with an itching or burning sensation. (Image courtesy of the Centers for Disease Control and Prevention.)
Kissing bug
Triatomid, the kissing bug, can carry Chagas' disease (American trypanosomiasis). (Image courtesy of the Centers for Disease Control and Prevention.)
Bedbug - close-up
Bed bugs bites can leave a colorless welt along with an itching or burning sensation. (Image courtesy of the Centers for Disease Control and Prevention.)
Mosquito, adult feeding on the skin
There are many different species of mosquito, which can carry some of the world's most common and significant infectious diseases, including West Nile, Malaria, yellow fever, viral encephalitis, and dengue fever. (Image courtesy of the Centers for Disease Control and Prevention.)
Wasp
Wasps are not known to carry human diseases, but allergic reactions to their sting can be fatal. (Image courtesy of the Centers for Disease Control and Prevention.)
Insect stings and allergy
Allergic reaction to bee stings occurs when a person becomes sensitized to the venom from a previous sting. This reaction is different from the reaction to the poison in the bite of a black widow spider, which injects a potent toxin into the blood. Ordinarily, bee venom is not toxic and will only cause local pain and swelling. The allergic reaction comes when the immune system is oversensitized to the venom and produces antibodies to it. Histamines and other substances are released into the bloodstream, causing blood vessels to dilate and tissues to swell. Severe reactions can lead to anaphylactic shock, a life-threatening series of symptoms including swelling of the throat and difficulty breathing. Persons who develop an allergy to bee stings should carry prescription bee sting kits to counteract the reaction to bee venom.
Bedbug - close-up
Bed bugs bites can leave a colorless welt along with an itching or burning sensation. (Image courtesy of the Centers for Disease Control and Prevention.)
Bedbug - close-up
Bed bugs bites can leave a colorless welt along with an itching or burning sensation. (Image courtesy of the Centers for Disease Control and Prevention.)
Bedbug - close-up
Bed bugs bites can leave a colorless welt along with an itching or burning sensation. (Image courtesy of the Centers for Disease Control and Prevention.)
Flea
Different types of fleas prefer specific animals as hosts, but will infest humans if their specific hosts are unavailable. Fleas can carry plague and typhus. They are also thought to transmit several other diseases. (Image courtesy of the Centers for Disease Control and Prevention.)
Bedbug - close-up
Bed bugs bites can leave a colorless welt along with an itching or burning sensation. (Image courtesy of the Centers for Disease Control and Prevention.)
Insect bites on the legs
Insect bites may be grouped, raised (papular), hive-like (urticarial), and have a surrounding halo (bull's eye). Occasionally a central depression, or punctum, can be seen.
Head lice
Head lice infect the scalp and hair and can be seen at the nape of the neck and over the ears. Head lice spread easily and quickly but do not carry disease as other lice do.
Head lice
Head lice infect the scalp and hair and can be seen at the nape of the neck and over the ears. Head lice spread easily and quickly but do not carry disease as other lice do.
Head lice
Head lice infect the scalp and hair and can be seen at the nape of the neck and over the ears. Head lice spread easily and quickly but do not carry disease as other lice do.
Body louse
This is a magnified view of a body louse. Lice produce itching and a characteristic skin rash, which looks like a scrape. Lice may also carry organisms that cause relapsing fever, typhus, and trench fever. (Image courtesy of the Centers for Disease Control and Prevention.)
Body louse, female and larvae
This is a magnified view of a female body louse with larvae. Lice cause itching and a characteristic excoriated skin rash (looks like a scrape). They may also transmit diseases, including relapsing fever, typhus, and trench fever. (Image courtesy of the Centers for Disease Control and Prevention.)
Crab louse, female
This is a photomicrograph of a female pubic louse. The condition known as crabs is so named because of the resemblance of a pubic louse to a crab. The bodies of pubic lice are shorter and rounder than those of head lice. (Image courtesy of the Centers for Disease Control and Prevention.)
Crab louse, female
This is a photomicrograph of a female pubic louse. The condition known as crabs is so named because of the resemblance of a pubic louse to a crab. The bodies of pubic lice are shorter and rounder than those of head lice. (Image courtesy of the Centers for Disease Control and Prevention.)
Crab louse, female
This is a photomicrograph of a female pubic louse. The condition known as crabs is so named because of the resemblance of a pubic louse to a crab. The bodies of pubic lice are shorter and rounder than those of head lice. (Image courtesy of the Centers for Disease Control and Prevention.)
Arthropods - basic features
Many arthropods are capable of carrying disease. This illustration shows some of the general characteristics of arthropods.
Bedbug - close-up
Bed bugs bites can leave a colorless welt along with an itching or burning sensation. (Image courtesy of the Centers for Disease Control and Prevention.)

References

Boyer LV, Binford GJ, Degan JA. Spider bites. In: Auerbach PS, Cushing TA, Harris NS, eds. Auerbach's Wilderness Medicine. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 43.

Ennik F. Deaths from bites and stings of venomous animals. West J Med. 1980;133(6):463-468. www.ncbi.nlm.nih.gov/pmc/articles/PMC1272387/.

Otten EJ. Venomous animal injuries. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 55.

Patterson JW. Arthropod-induced diseases. In: Patterson JW, ed. Weedon's Skin Pathology. 5th ed. Philadelphia, PA: Elsevier Limited; 2021:chap 31.

Seifert SA, Dart R, White J. Envenomation, bites, and stings. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 104.

Suchard JR. Scorpion envenomation. In: Auerbach PS, Cushing TA, Harris NS, eds. Auerbach's Wilderness Medicine. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 44.

Last reviewed November 13, 2021 by Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team..

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