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Bee, wasp and ant stings
Medical expert of the article
Last reviewed: 07.07.2025
Stinging insects belong to the order Hymenoptera. The main subgroups are:
- apiforms (e.g. bees, bumblebees);
- true wasps (e.g. wasps, hornets);
- ants (e.g. wingless fire ants).
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Symptoms of Bee, Wasp and Ant Stings
Local reactions to bee and wasp stings include burning, itching, transient pain, hyperemia of several centimeters, swelling, and induration. The swelling and hyperemia usually peak within 48 hours but may persist for a week and extend to the entire limb. This local chemical cellulitis is often confused with secondary cellulitis, which is more painful and less common. An allergic reaction may manifest as urticaria, angioedema, bronchospasm, refractory hypotension, or a combination of these symptoms; swelling without other symptoms does not indicate an allergic reaction.
Symptoms and manifestations of fire ant bites are immediate pain, accompanied by the formation of a papule and hyperemia, which often disappears within 45 minutes and gives rise to a sterile pustule, which subsides within 30-70 hours. The bite site can in some cases become infected and lead to sepsis. Sometimes, instead of a pustule, swelling, hyperemia or itching develop. In the case of a fire ant bite, anaphylactic shock is observed in less than 1% of victims. There are reports of the development of seizures and mononeuritis.
Bee stings
Bees do not usually sting unless provoked, but African honeybees (killer bees), which migrated from South America and live in some southern American states, are especially aggressive if disturbed. Bees usually sting once, leaving a barbed stinger in the wound that releases venom and kills the insect. Melittin is considered the main pain-causing component of the venom. Killer bees have venom that is no more potent than that of regular bees, but they cause much more serious consequences because they attack in a swarm and inflict multiple stings, bringing the dose of poison to a lethal concentration. In the United States, bees kill three to four times more people per year than venomous snakes.
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Wasp stings
The stings of true wasps have few barbs and do not remain in the skin, so the insects can sting multiple times. The venom contains phospholipase, hyaluronidase, and a protein called antigen 5, which causes the most allergic reaction. True wasps, like bees, do not sting unless provoked. They nest near people, which often creates provoking situations. Hornets are the most common cause of allergic reactions to insect bites in the United States.
Ant bites
Fire ants are found in the southern United States in the Gulf of Mexico region, where they bite up to 40% of the urban population. There are several species, but fire ants are dominant and are responsible for a growing number of allergic reactions. The insect stings by fixing itself to the victim, and stings repeatedly by rotating its body in an arc around the bite, forming a characteristic central bite surrounded by a red line. The venom has hemolytic, cytolytic and antimicrobial properties; 3-4 fractions of dissolved proteins are probably what cause the allergic reaction.
Hymenoptera venoms cause local toxic reactions in all humans and allergic reactions in susceptible individuals. Severity depends on the dose and the degree of susceptibility. Victims exposed to a swarm and having high levels of venom-specific IgE are most likely to develop anaphylactic shock; in many children, the risk does not decrease with age. On average, humans can tolerate 22 stings per kilogram of body weight; i.e., the average adult can survive >1000 stings, whereas 500 stings can kill a child.
Treatment of bee, wasp and ant stings
If the sting remains in the wound, it should be removed as quickly as possible, no matter what the method. An ice cube should be immediately placed on the bite area; H2 receptor blockers and NSAIDs are prescribed orally to relieve pain. Allergic reactions are treated with antihistamines; in case of anaphylactic shock, epinephrine and vasoconstrictors are used.
People with increased sensitivity to insect bites should carry a kit containing a syringe of epinephrine and seek medical attention immediately if signs of an allergic reaction appear.
Prevention of bee, wasp and ant stings
People who have had anaphylactic shock or who have positive allergy tests and are at high risk for insect bites should receive immunotherapy regardless of age or time since the last anaphylactic shock. Venom immunotherapy is very effective, reducing the risk of recurrence of anaphylactic shock from 50 to 10% after 2 years of treatment and to approximately 2% after 3-5 years of treatment. Children who have received venom immunotherapy have a significantly lower risk of systemic reactions to insect bites in the period of 10-20 years after treatment. Venom immunotherapy is safe during pregnancy. Desensitization is recommended and performed when treating one type of venom. After initial immunotherapy, maintenance doses may be needed for 5 years.