Bee stings are a common outdoor nuisance. In most cases, bee stings are just annoying and pain and swelling go away quickly. Usually home treatment is all that's necessary to ease the pain of bee stings. But if you're allergic to bee stings or you get stung numerous times, you may have a more serious reaction that requires emergency treatment. You can take several steps to avoid bee stings — and find out how to treat them if you do get stung.

Bee sting symptoms include:

• Instant, sharp burning pain at the sting site
• A red welt at the sting area
• A small, white spot where the stinger punctured the skin
• Slight swelling around the sting area

In most people, swelling and pain go away within a few hours and only cause minor discomfort.

Allergic reactions
If you're allergic to bee stings, you'll have a more serious reaction. Symptoms can range from mild to severe. Most severe allergic reactions to bee stings develop within minutes of the sting, but in some cases, serious reactions around the bee sting area can take hours or even a few days to develop. Even if you've only had a minor reaction to bee stings in the past, it's possible to have a more serious allergic reaction the next time you get stung.

Signs and symptoms of an allergic reaction to bee stings can include:

• A large area of swelling (edema) at the sting site
• Itching or hives all over your body
• Cough, chest tightness, wheezing or shortness of breath

A severe allergic reaction to bee stings can cause:

• Lightheadedness
• Loss of consciousness
• Upset stomach, diarrhea, nausea, vomiting or other digestive issues

Anaphylaxis
A medical emergency, anaphylaxis is a full-blown allergy attack that can be life-threatening. If you have symptoms of anaphylaxis following a bee sting, seek emergency treatment immediately. Signs and symptoms include:

• Skin reactions in parts of the body other than the sting area, including hives and itching and flushed or pale skin (almost always present with anaphylaxis)
• Difficulty breathing
• Swelling of the throat and tongue or other areas of the body
• A weak and rapid pulse
• Nausea, vomiting or diarrhea
• Dizziness or fainting
• Loss of consciousness

Multiple bee stings
Most honeybees or bumblebees aren't aggressive and only sting in self-defense. In most cases, this results in one or perhaps a few bee stings. However, in some cases a person will disrupt a hive or swarm of bees and get stung multiple times. Some types of bees — such as Africanized honeybees — are more likely than are other bees to swarm, stinging in a group.

Bee stings are rarely fatal, in spite of dramatic movie scenes that might make you believe otherwise. But if you get stung more than a dozen stings, you may feel quite sick. Multiple stings can be a medical emergency in children, older adults, and people who have heart or breathing problems.

When to see a doctor
In most cases, bee stings are a minor problem that gets better quickly with home treatment. However, if you have a serious reaction, you'll need medical attention.

• Call 911 or other emergency services if you're having a serious reaction to a bee sting that includes dizziness, lightheadedness, loss of consciousness, trouble breathing, swelling of the throat or hives. If you were prescribed an emergency epinephrine autoinjector (EpiPen, Twinject), use it right away as your doctor directed.
• Make an appointment to see your doctor if bee sting symptoms don't go away within a few days, or if you've had other symptoms of an allergic response following a bee sting.

Bee sting venom contains proteins that affect skin cells and the immune system, causing pain and swelling around the sting area. In people with a bee sting allergy, bee venom can trigger a more serious immune system reaction.

You're at increased risk of bee stings if:

• You live in an area where bees are especially active
• Your work or hobbies require spending time outside
• You live in an area with beehives nearby

You're more likely to have an allergic reaction to bee stings if:

• You have other allergies, such as hay fever (allergic sinusitis)
• You had an allergic reaction to a bee sting in the past, even if it was minor

Generally, bee stings don't cause any serious problems and symptoms get better within a few hours. However, there are possible complications.

• If you're allergic to bees, stings can cause a more serious reaction. You may be at risk of a life-threatening anaphylactic attack that requires an emergency shot of epinephrine and a trip to the emergency room.
• Multiple bee stings can be dangerous, especially in children. Because children are smaller than adults, fewer stings can create high levels of bee venom in the bloodstream.
• Infection at the site of a sting. As with other cases when the skin is broken, a bee sting site may become infected. Scratching a bee sting site can increase your risk of infection.

If you've had a severe reaction to a bee sting, you need to see your doctor to check whether you may be allergic to bee venom. Your doctor will do a thorough physical examination and ask a number of questions. Your doctor will want to know:

• Exactly what symptoms you had after getting stung
• Whether you've had an allergic reaction to an insect sting in the past, even if it was minor
• Whether you have any other allergies, such as hay fever
• What medications you take, including herbal remedies
• Any health problems you have

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. You might want to ask the following questions:

• What do I do if I get stung in the future?
• If I have an allergic reaction, do I need to use emergency medication such as an epinephrine autoinjector (EpiPen, Twinject)?
• How can I prevent this from happening again?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

Click to Enlarge

Positive reaction to allergy test

If you've had a reaction to bee stings that suggests you might be allergic to bee venom, your doctor may suggest one or both of the following tests:

• Skin prick test. During skin testing, a small amount of purified allergen extract (in this case, bee venom) is pricked into the skin of your arm or upper back. This test is safe and won't cause any serious reactions. If you're allergic to bee stings, you develop a raised bump (hive) at the test location on your skin. Allergy specialists usually are best equipped to perform allergy skin tests.
• Allergy blood test. A blood test (sometimes called the radioallergosorbent, or RAST, test) can measure your immune system's response to bee venom by measuring the amount of allergy-causing antibodies in your bloodstream, known as immunoglobulin E (IgE) antibodies. A blood sample is sent to a medical laboratory, where it can be tested for evidence of sensitivity to possible allergens.

Allergy skin tests are the most accurate tests for insect allergies. But if the allergy skin test is negative — and your doctor still thinks you might have a stinging insect allergy — you may need an allergy blood test to double-check. Your doctor may also want to test you for allergies to yellow jackets, hornets and wasps — which can cause similar allergic reactions to bee stings.

Click to Enlarge

Removing a bee's stinger

For most bee stings, home treatment is enough. For more serious reactions, you may need to see your doctor or go to the emergency room. Multiple stings or an allergic reaction can be a medical emergency that requires immediate treatment.

Bee sting first aid
When a bee stings, it jabs a barbed stinger into the skin. Removing the stinger and attached venom sac right away will keep more venom from being released.

• Remove the stinger as soon as you can. Scrape the stinger out with the edge of a credit card, a fingernail, or use a pair of tweezers. Avoid squeezing the attached venom sac, which can release more venom.
• Wash the sting area with soap and water.
• Put a cold pack or a cloth filled with ice on the sting area. This will help reduce swelling.
• Apply hydrocortisone cream or calamine lotion to ease redness, itching or swelling.
• Take an oral antihistamine that contains diphenhydramine if itching or swelling is bothersome (Benadryl, Tylenol Severe Allergy) or chlorpheniramine (Chlor-Trimeton).
• Don't scratch the sting area. This will worsen itching and swelling — and increase your risk of infection.

Emergency treatment for allergic reactions
If you're allergic to bee stings, your doctor will likely prescribe an emergency epinephrine autoinjector (EpiPen, TwinJect). You'll need to carry it with you at all times during seasons when bees are active. An autoinjector is a combined syringe and concealed needle that injects a single dose of medication when pressed against your thigh. Always be sure to replace epinephrine before its expiration date, or it may not work properly.

Be sure you know how to use the autoinjector. Also, make sure the people closest to you know how to administer the drug — if they're with you in an anaphylactic emergency, they could save your life. Medical personnel called in to respond to a severe anaphylactic reaction also may give you an epinephrine injection or another medication.

Allergy shots
If you're diagnosed with a bee sting allergy, your doctor may suggest getting allergy shots (immunotherapy). These shots are generally given on a regular basis for a few years and can reduce or completely eliminate your allergic response to bee venom.

Although they haven't been tested by research studies, common home remedies may help decrease the effects of bee venom:

• Rub a wet aspirin on the sting area.
• Make a paste with baking soda or meat tenderizer and water. Leave it on the sting area for a few minutes.
• Rub aloe vera or calendula leaves on the sting area.
• Put a slice of onion on the sting area for a few minutes.

A number of prevention strategies can help you minimize your chance of getting stung by bees.

Avoid scents and colors that attract bees:

• Stay away from blooming flowers and ripe fruit.
• Avoid eating sweet foods outside.
• Don't use perfume, cologne, scented soap or other strong-smelling personal products.
• Wear light-colored clothes and avoid bright patterns.

Minimize your exposure:

• Wear a long-sleeved shirt, gloves and a hat.
• Wear shoes when walking outside.
• When driving, keep your windows rolled up.
• If you're concerned about being stung, have bee hives near your home removed by a professional.

Know what to do when you're exposed to bees:

• If bees are flying around you, stay calm. Swatting at an insect may cause it to sting.
• If a bee stings you, quickly leave the area. When it stings, a bee releases a chemical that attracts other bees.

Preventing an allergic reaction and anaphylaxis
Bee stings are a common cause of allergic reactions. See your doctor if you've had any signs of an allergic reaction following a bee sting. Identifying a bee sting allergy and taking precautions can help prevent allergic reactions.

• Talk to your doctor about an emergency epinephrine injector (EpiPen, TwinJect) for emergency use following a bee sting.
• Wear a medical ID bracelet that lets people know you have a bee sting allergy, in case you have a serious reaction and cannot communicate.
• If your doctor thinks it's a good idea, consider getting shots to prevent an allergic reaction (immunotherapy).