Reactions to the sting of honeybees, hornets, yellow jackets, and wasps can consist of normal reactions, large local reactions and systemic (generalized) reactions.
Normal reactions typically include intense pain, itching, and redness with swelling at the sting site up to the size of quarter. Large local reactions extend out from the site of the sting and involve redness with swelling that can at times involve the entire arm or leg. These can be very uncomfortable and may limit mobility of a joint such as the elbow or knee. Systemic reactions can include generalized hives, swelling of the tongue or throat, wheezing with difficulty breathing and a drop in blood pressure. These can be life-threatening and it is estimated that there are about 50 deaths each year in the U.S. from bee stings.
As allergists, we take a careful history of the reaction and examine any E.R. records that resulted from the reaction. We then perform skin tests to look for allergic antibody that may be present against any of the stinging insect species listed above. If a systemic reaction occurred and skin tests are positive we can then offer allergy shots against the venom of the offending insect(s) to make it much less likely (95-97% effective) that you will react to stings in the future. You will also be prescribed self-injectable epinephrine until the shot treatment is completed (typically 4 to 5 years). Large local reactions are rarely treated with shots unless they have been severe or very frequent. A short course of oral or injectable steroid along with antihistamines can help keep you comfortable and hasten resolution of the swelling.
