Tag Archive for: bee sting anaphylaxis

A bee sting allergy is the one situation where a single sting from any honey bee, Africanized or not, can be life-threatening. For most people a sting means pain, a red welt, and some swelling. For a small number, the immune system overreacts and triggers anaphylaxis, a whole-body emergency. This guide explains the difference, the warning signs to watch for, what to do in the first minutes, and how allergists treat sting allergy long term. It’s part of our Killer Bees 101 guide.

This page is general information, not medical advice. If someone has trouble breathing or swelling of the throat or tongue after a sting, call 911 now.

Quick answer: what are the signs of a bee sting allergy?

A normal reaction stays at the sting site: pain, redness, swelling, and itching. An allergic reaction (anaphylaxis) spreads through the body, usually within minutes. The American Academy of Allergy, Asthma & Immunology (AAAAI) lists signs that include hives and itching, swelling in the throat or tongue, difficulty breathing, dizziness, stomach cramps, nausea, or diarrhea, and in severe cases a sudden drop in blood pressure, shock, and loss of consciousness. Use epinephrine if it’s been prescribed and call 911.

What causes a bee sting allergy?

The AAAAI explains that in an allergic person, the first sting causes the body to produce an antibody called immunoglobulin E (IgE). If that person is stung again by the same kind of insect, the venom interacts with that IgE and triggers the release of substances that cause an allergic reaction. The National Library of Medicine’s MedlinePlus describes the result as histamine and other chemicals released throughout the body, which tighten the airways and cause the other symptoms.

That’s why someone can be stung once without trouble and react badly the next time.

How common is it?

A Cochrane review of venom treatment estimates that at least 1 in 200 people have had a severe allergic reaction to a sting from a bee, wasp, or ant. CDC data show that hornet, wasp, and bee stings caused 788 deaths in the United States from 2011 to 2021, an average of 72 a year, and 84% of those who died were male. Those CDC numbers count every death coded to stings, not only allergic reactions.

Bee sting allergy vs. a normal reaction

Normal local reaction

The AAAAI says most stings cause redness, swelling, and itching at the site. University of Arizona Extension says the discomfort and swelling can last 2–3 days. University of Florida (UF/IFAS) entomologists stress that “swelling around the stung area is normal and not an indication of systematic allergy.”

Large local reaction

Some people get swelling that grows much larger than usual around the sting. The Cochrane review treats these “large local reactions” as a separate category from systemic (whole-body) reactions. The AAAAI advises seeing a physician if swelling keeps progressing or the site looks infected.

Anaphylaxis (systemic reaction)

UF/IFAS describes the red flags: difficulty breathing, hives covering large areas of the body, nausea, vomiting, and swelling away from the sting site. “The latter suggests a systemic reaction.” MedlinePlus adds chest tightness, wheezing, trouble swallowing, slurred speech, swelling of the face, eyes, or tongue, anxiety, palpitations, and unconsciousness, and notes that symptoms “develop quickly, often within seconds or minutes.”

MedlinePlus also flags one easy-to-miss warning sign of dangerous throat swelling: a very hoarse or whispered voice, or coarse sounds when breathing in.

What to do for an allergic reaction to a bee sting

MedlinePlus and the AAAAI give these steps:

1. Call 911 or your local emergency number right away.
2. Use epinephrine immediately if the person has an auto-injector or nasal spray. MedlinePlus says “there is no contraindication to using epinephrine in a severe allergic reaction.”
3. Scrape out the stinger with something firm, like a fingernail or plastic card. Don’t use tweezers; MedlinePlus says squeezing releases more venom. The AAAAI advises getting it out within 30 seconds if you can.
4. Help prevent shock. Have the person lie flat with feet raised about 12 inches and cover them with a coat or blanket, unless they have a head, neck, back, or leg injury, are vomiting, or it’s uncomfortable.
5. Don’t put a pillow under the head if they’re struggling to breathe, and don’t give anything by mouth.
6. Go to the emergency room even if epinephrine works. The AAAAI says epinephrine “is a rescue medication only,” and the person still needs emergency care.

Carry two doses

If you’ve been prescribed epinephrine, the AAAAI says to carry two devices, because “1/3 of the time a second dose is needed.” Learn how to use them and replace them before they expire. The CDC’s National Institute for Occupational Safety and Health (NIOSH) also recommends that workers with a history of severe sting reactions carry epinephrine and wear a medical ID bracelet or necklace.

Many stings vs. one allergic sting

Killer bee attacks add a second danger: toxic envenomation from many stings, even in people who aren’t allergic. UF/IFAS says there’s a risk of venom overdose after about 5–10 stings per pound of body weight, and recommends medical attention for numerous stings. University of Arizona says to seek care after more than 15 stings.

Allergy is different. UF/IFAS points out that for an allergic person, “a single sting can cause death,” regardless of whether the bee is Africanized. Africanized bee venom is no more potent than a European honey bee’s; the danger from killer bees is the number of stings. More detail is in How Dangerous Is a Killer Bee Sting?

Long-term treatment: venom allergy shots

If you’ve had a serious reaction, the AAAAI recommends seeing an allergist for testing and a treatment plan. One proven option is venom immunotherapy, which Cochrane describes as treatment with insect venom, “usually given by a course of injections.”

A Cochrane systematic review of seven trials found that venom immunotherapy cut the chance of another serious allergic sting reaction by about 90%. In those trials, 2.7% of treated people had a systemic reaction to a later sting, compared with 39.8% of untreated people. The treatment also improved quality of life. It carries a small risk: about 1 in 10 people treated in the trials had an allergic reaction to the treatment itself, which is why it’s done under medical supervision.

Preventing stings if you’re allergic

Combining AAAAI, NIOSH, and extension advice:

• Wear light-colored, smooth-finished clothing and avoid perfume, cologne, and scented toiletries (NIOSH).
• Be careful with sweet drinks outdoors. The AAAAI warns about insects inside straws and cans; University of Arizona Extension notes bees often crawl into open soda cans.
• Wear closed-toe shoes and avoid loose clothing that can trap insects (AAAAI).
• Tell the people you’re with about your allergy so they can respond (UF/IFAS).
• Have nests removed by professionals rather than tackling them yourself. See How to Get Rid of Killer Bees.
• Know which insect is which. NC State Extension notes that yellowjackets and hornets are often mistaken for honey bees. Our guide Killer Bees vs. Murder Hornets, Yellowjackets, and Wasps shows the differences.

If you live where Africanized bees are established, learn the escape plan in What to Do If Killer Bees Attack.

Frequently asked questions

How long after a bee sting can an allergic reaction start?

Usually fast. MedlinePlus says anaphylaxis symptoms often develop within seconds or minutes. Watch anyone who has been stung, and get help immediately if symptoms spread beyond the sting site.

Is swelling after a bee sting an allergy?

Not by itself. UF/IFAS says swelling around the sting is normal. Warning signs are hives over large areas, swelling away from the sting, trouble breathing, or vomiting.

Can you suddenly become allergic to bee stings?

Yes. The AAAAI explains that allergic people make IgE antibodies after a sting, so a later sting can trigger a reaction even if the first one didn’t.

Is a killer bee sting worse for someone with an allergy?

A single Africanized bee sting carries the same allergy risk as any honey bee sting, because the venom is the same. The added danger is that killer bees sting in much larger numbers.

Do bee allergy shots work?

Yes. A Cochrane review found venom immunotherapy reduced the risk of a serious allergic reaction to a future sting by about 90%.

Should I go to the ER after using an EpiPen?

Yes. The AAAAI says epinephrine is a rescue medication only, and you still need emergency care.

Sources

• American Academy of Allergy, Asthma & Immunology, “Stinging Insect Allergy”
• MedlinePlus (U.S. National Library of Medicine), “Anaphylaxis”
• Cochrane, “Immunotherapy for preventing allergic reactions to insect stings” (Boyle et al., 2012)
• CDC MMWR QuickStats, “Number of Deaths from Hornet, Wasp, and Bee Stings, 2011–2021”
• CDC NIOSH, “Insects and Scorpions at Work”
• UF/IFAS EDIS ENY-170, “Living with the African Honey Bee”
• UF/IFAS EDIS EENY-429, “African Honey Bee, Africanized Honey Bee, Killer Bee”
• University of Arizona Extension AZ1846, “Wild Honey Bees in Community Environments”
• University of Arizona, “They are called Africanized Honey Bees”
• NC State Extension, “Africanized Honey Bees: Prevention and Control”