II. Epidemiology

  1. Peak Incidence in August
  2. Hymenoptera most common cause of serious venom reaction
    1. Systemic Allergic Reaction: 5% of patients
    2. Anaphylaxis: <1% of patients

III. Causes

  1. Yellow jacket Wasps
    1. Attracted to food and garbage containers
    2. Attack without provocation
    3. Nest in crevasses or burrows
      1. Disturbance of a nest may lead to attacks (>10)
  2. Hornets and assorted wasps
    1. Nest on undersurfaces of decks and roof overhangs
    2. Attack in small groups (1-5) if nest disturbed
  3. Bumblebees and Honeybees
    1. Not aggressive unless hives attacked
  4. Africanized Honeybees (Killer Bees)
    1. Attack in swarms of hundreds
    2. Pursue victims well away from the hive
    3. In U.S. found in Arizona, California and Texas
  5. Fire Ants (Solenopsis species)
    1. Nest in the ground
    2. Attack in swarms when nest is attacked

IV. Signs: Local Reactions

  1. Bees/Wasps (Venom contains biogenic amines)
    1. Erythematous Papules develop in seconds
    2. Larger areas of edema and Urticaria may develop
    3. Lesions subside in 4-6 hours
    4. Some extensive local reactions persist for days
  2. Fire ants (Venom contains alkaloids)
    1. Arc shaped lesions
    2. Sterile Pustules develop within 24 hours
  3. Honeybee
    1. Barbed Stinger remains in skin after sting
      1. Injection continues until Stinger removed
      2. Do NOT grasp Stinger - will inject more venom
    2. Technique to remove Stinger
      1. Scrape sharp object (knife) horizontally over skin
      2. Drags Stinger out intact

V. Signs: Systemic Reaction

  1. Systemic Reaction or Anaphylaxis
    1. Onset of reaction within 20 minutes of sting
  2. Serum Sickness
    1. Rare complication of Insect Bite
    2. Occurs 7-14 days after large dose of venom
    3. Arthralgia and fever
    4. Urticaria with Angioedema

VI. Complications (rare - case reports)

VII. Management

  1. Local Reaction
    1. Ice Packs
    2. Analgesics
    3. Unproved efficacy of:
      1. Antihistamines and Corticosteroids
      2. Topical papain (meat tenderizer) or baking soda
  2. Systemic Allergic Reaction or Anaphylaxis Management
  3. Serum Sickness
    1. Systemic steroids
    2. Antihistamines

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Ontology: Bees (C0004923)

Definition (MSH) Insect members of the superfamily Apoidea, found almost everywhere, particularly on flowers. About 3500 species occur in North America. They differ from most WASPS in that their young are fed honey and pollen rather than animal food.
Definition (MSHCZE) Hmyz z nadčeledi Apoidea, který se nachází téměř všude, obzvláště na květech. V Severní Americe se vyskytuje asi 3500 druhů. Od většiny VOS se liší tím, že své potomstvo krmí spíše medem a pylem než živočišnou potravou.
Concepts Eukaryote (T204)
MSH D001516
SnomedCT 106820008, 31141000009100, 28482008
Swedish Bin
Czech včely
Finnish Mehiläiset
Russian PCHELY, ПЧЕЛЫ
English Bees, bee, bees, Family apoidea - bee (organism), Superfamily Apoidea (organism), Apoidea, Superfamily Apoidea, Bee, Family apoidea - bee, Bee (organism), Bee, NOS
Croatian PČELE
French Abeilles
Polish Pszczoły
Spanish familia apoidea - abeja (concepto no activo), familia apoidea - abeja, Jalea Real, abeja (organismo), abeja, Abejas
Norwegian Bier
Portuguese Geleia Real, Abelhas
German Bienen
Italian Api
Dutch Bij, Bijen

Ontology: Wasps (C0043041)

Definition (MSH) Any of numerous winged hymenopterous insects of social as well as solitary habits and having formidable stings.
Definition (PSY) Any of numerous social or solitary winged hymenopterous insects.
Concepts Eukaryote (T204)
MSH D014863
SnomedCT 88030006
English Wasps, wasps, wasp, Wasp, Wasp (organism), Wasp, NOS
Swedish Getingar
Finnish Ampiaiset
Russian OSY NASTOIASHCHIE, OSY, ОСЫ, ОСЫ НАСТОЯЩИЕ
Croatian OSE
French Guêpes
Polish Osy
Czech sršňovití, vosovití, vosy
Norwegian Vepser
Spanish avispa (organismo), avispa, Avispas
German Wespen
Italian Vespe
Dutch Wesp, Wespen
Portuguese Vespas

Ontology: Wasp sting (C0413119)

Concepts Injury or Poisoning (T037)
SnomedCT 157931003, 210984001, 241819002
Dutch wespensteek
French Piqûre de guêpe
German Wespenstich
Italian Puntura di vespa
Portuguese Picada de vespa
Spanish Picadura de avispa, picadura de avispa (trastorno), picadura de avispa
Japanese スズメ蜂刺傷, スズメバチサシキズ, スズメバチシショウ
Czech Vosí bodnutí
English sting wasp, stings wasps, wasp sting, Sting;wasp, stings wasp, Wasp sting, Wasp sting (disorder)
Hungarian Darázscsípés

Ontology: Bee sting (C0413120)

Concepts Injury or Poisoning (T037)
SnomedCT 157930002, 210984001, 241820008
Dutch bijensteek
German Bienenstich
Italian Puntura d'ape
Portuguese Picada de abelhas
Spanish Picadura de abeja, picadura de abeja (trastorno), picadura de abeja
Japanese 蜂刺傷, ハチシショウ, ハチサシキズ
French Piqûre d'abeille
English bee sting (diagnosis), injury caused by bee sting, bee sting, Sting;bee, bee stings, Bee Stings, Bee sting, Bee sting (disorder)
Czech Včelí bodnutí
Hungarian Méhcsípés

Ontology: Hymenoptera sting (C1274548)

Concepts Injury or Poisoning (T037)
SnomedCT 403142004
English Hymenoptera sting (disorder), Hymenoptera sting
Spanish picadura de himenópteros (trastorno), picadura de himenópteros