Bees, wasps and stinging ants

From the order hymenoptera, the honey bee (Apis mellifera), the European wasp (Vespula germanica) and ants from the genus Myrmecia are important causes of mortality or morbidity. Most often their sting causes a painful local reaction with little systemic effect. However in sensitized individuals these stings can cause severe local and/or generalized allergic reactions, including anaphylaxis.

Note Dose-dependent toxicity can sometimes be significant with multiple bee and European wasp stings. Haemolysis, rhabdomyolysis and metabolic derangement may precede clinical deterioration.

First Aid and Medical Treatment Bee stings should always be scraped off. Never pull them off, as this may cause further injection of venom from the venom gland which remains attached to the sting. In non-allergic persons iced water usually relieves the pain of local reactions. Antihistamines should be considered for significant itch. Treatment of toxicity due to massive envenomation includes supportive care and close medical monitoring.

In allergic patients, the pressure-immobilisation procedure should be used and medical care sought immediately. Patients who have suffered severe reactions should always have access to injectable adrenaline and know how to use it. Oral and topical steroids may be useful for managing large local reactions. Purified venoms are available for use in immunotherapy for the honey bee, European wasp and some paper wasps. International experience suggests immunotherapy may have an efficacy of up to 98%.