Deep Vein Thrombosis After a Wild Bee Sting

Case Reports

. 2022 Jan 1;44(1):e241-e242.

doi: 10.1097/MPH.0000000000002072.

Metin Cil 
¹
, Goksel Leblebisatan 
¹
, Serife Leblebisatan 
²
, Adnan Barutcu 
³
, Merve K Cil 
⁴
, Yurdanur Kilinc 
¹

Affiliations

Affiliations

• ¹ Departments of Pediatric Hematology.
• ² Department of Radiology, Adana City Training and Research Hospital, Adana, Turkey.
• ³ Pediatrics.
• ⁴ Pediatric Infectious Disease, Cukurova University Medical Faculty.

• PMID:

  33512868

• DOI:

  10.1097/MPH.0000000000002072

Case Reports

Metin Cil et al.

J Pediatr Hematol Oncol.

2022.

. 2022 Jan 1;44(1):e241-e242.

doi: 10.1097/MPH.0000000000002072.

Authors

Metin Cil 
¹
, Goksel Leblebisatan 
¹
, Serife Leblebisatan 
²
, Adnan Barutcu 
³
, Merve K Cil 
⁴
, Yurdanur Kilinc 
¹

Affiliations

• ¹ Departments of Pediatric Hematology.
• ² Department of Radiology, Adana City Training and Research Hospital, Adana, Turkey.
• ³ Pediatrics.
• ⁴ Pediatric Infectious Disease, Cukurova University Medical Faculty.

• PMID:

  33512868

• DOI:

  10.1097/MPH.0000000000002072

Abstract

Allergic reactions from insect bites are mostly observed with bee stings. Bee sting reactions can be classified into 3 main headings: local, systemic, and rare reactions. Vascular thrombosis is considered both in rare and systemic reactions. The wild bee venom induces the secretion of many inflammatory mediators, including histamine, phospholipase A1, and thromboxane, leading to vasoconstriction and thrombosis. Inflammatory cytokines also cause endothelial injury and deterioration of the microcirculation. In the literature, rare reactions have been reported including various central and arterial vascular pathologies such as aortic thrombosis, cerebral infarction, and myocardial infarction; however, there is rare publication concerning peripheral deep vein thrombosis (DVT). Although DVT produces good results with effective and rapid treatment, it can be fatal because of causes such as pulmonary embolism in the absence of timely intervention. Herein, for the first time in the literature, we present a pediatric case of peripheral DVT after a wild bee sting.

Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

Conflict of interest statement

w3.org/1999/xlink” xmlns:mml=”http://www.w3.org/1998/Math/MathML” xmlns:p1=”http://pubmed.gov/pub-one”>The authors declare no conflict of interest.

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References

1. 1. Valla M, Moulin F, Angioi M, et al. Myocardial infarction in a 45-year-old man following an anaphylactic reaction to a wasp sting. Int J Cardiol. 2011;148:63–65.

2. 1. Ebo DG, Hagendorens MM, Stevens WJ. Hymenoptera venom allergy. Expert Rev Clin Immunol. 2005;1:169–175.

3. 1. Yang H, Xu X, Ma D, et al. A phospholipase A1 platelet activator from the wasp venom of Vespa magnifica (Smith). Toxicon. 2008;51:289–296.

4. 1. Lehr HA, Bihinger F, Kirkpatrick CJ. Microcirculatory dysfunction in sepsis: a pathogenetic basis for therapy? J Pathol. 2000;190:373–386.

5. 1. Minai­Flemnger Y, Lev­Schaffer F. Mast cells and eosinophils: the two key effector cells in allergic inflammation. Inflamm Res. 2009;58:631–638.

Publication types

MeSH terms

Bee poison Information | Mount Sinai

Apitoxin; Apis venenum purum; Insect sting; Insect bite; Wasp sting; Hornet sting; Yellow jacket sting

This article describes the effects of a sting from a bee, wasp, hornet, or yellow jacket.

This article is for information only. DO NOT use it to treat or manage an actual poisoning from a sting. If you or someone you are with is stung, call your local emergency number (such as 911), or your local poison center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States.

Allergic reaction to bee stings occurs when a person becomes sensitized to the venom from a previous sting. This reaction is different from the reaction to the poison in the bite of a black widow spider, which injects a potent toxin into the blood. Ordinarily, bee venom is not toxic and will only cause local pain and swelling. The allergic reaction comes when the immune system is oversensitized to the venom and produces antibodies to it. Histamines and other substances are released into the bloodstream, causing blood vessels to dilate and tissues to swell. Severe reactions can lead to anaphylactic shock, a life-threatening series of symptoms including swelling of the throat and difficulty breathing. Persons who develop an allergy to bee stings should carry prescription bee sting kits to counteract the reaction to bee venom.

Poisonous Ingredient

Bee, wasp, hornet, and yellow jacket stings contain a substance called venom.

Of these insects, Africanized bee colonies are very sensitive to being disturbed. When they are disturbed, they respond faster and in greater numbers than other types of bees. They are also much more likely to sting than European bees.

You are also at risk for stings if you disturb a wasp, hornet, or yellow jacket nest.

Where Found

Bee, wasp, hornet, and yellow jacket venom can cause an allergic reaction in some people.

Symptoms

Below are symptoms of a bee, wasp, hornet, or yellow jacket sting in different parts of the body.

EYES, EARS, NOSE, AND THROAT

• Swelling in the throat, lips, tongue, and mouth *

HEART AND BLOOD VESSELS

• Rapid heart rate
• Severe decrease in blood pressure*
• Collapse (shock) *

LUNGS

• Difficulty breathing *

SKIN

• Hives *
• Itching
• Swelling and pain at site of the sting

STOMACH AND INTESTINES

• Abdominal cramping
• Diarrhea
• Nausea and vomiting

* These symptoms are due to an allergic reaction, and not venom.

Home Care

If you have an allergy to stings from a bee, wasp, yellow jacket, or similar insect you should always carry an insect sting kit and know how to use it. These kits require a prescription. They contain a medicine called epinephrine, which you should take right away if you get a bee, wasp, hornet, or yellow jacket sting.

Call poison control or a hospital emergency room if the person who is stung has an allergy to the insect or was stung inside the mouth or throat. People with severe reactions may need to go to the hospital.

To treat the sting:

• Try to remove the stinger from the skin (if it is still present). To do this, carefully scrape the back of a knife or other thin, blunt, straight-edged object (like a credit card) across the stinger if the person can keep still and it is safe to do so. If you are pulling the stinger out, it is important to not pinch the venom sac at the end of the stinger. If this sac is squeezed or broken, more venom will be released.
• Clean the area thoroughly with soap and water.
• Place ice (wrapped in a clean cloth) on the site of the sting for 10 minutes and then off for 10 minutes. Repeat this process. If the person has problems with blood circulation, decrease the time that the ice is on the area to prevent possible skin damage.
• Keep the affected area still, if possible, to prevent the venom from spreading.
• Loosen clothing and remove rings and other tight jewelry.
• Give the person diphenhydramine (Benadryl and other brands) by mouth if they can swallow. This antihistamine drug may be used alone for mild symptoms.

Before Calling Emergency

Have this information ready:

• Person’s age, weight, and condition
• Type of insect, if possible
• Time of the sting
• Location of the sting

Poison Control

Your local poison control center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States. They will give you further instructions.

This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

What to Expect at the Emergency Room

The health care provider will measure and monitor the person’s vital signs, including temperature, pulse, breathing rate, and blood pressure. Symptoms will be treated. The person may receive:

• Blood and urine tests.
• Breathing support, including oxygen. Severe allergic reactions may require a tube down the throat and breathing machine (ventilator).
• Chest x-ray.
• ECG (electrocardiogram, or heart tracing).
• Intravenous fluids (IV, through a vein).
• Medicine to treat symptoms.

Outlook (Prognosis)

How well a person does depends on how allergic they are to the insect sting and how quickly they receive treatment. The faster they get medical help, the better the chance for recovery. The chances of future total body reactions increase when local reactions become more and more severe.

People who are not allergic to bees, wasps, hornets, or yellow jackets usually get better within 1 week.

DO NOT put your hands or feet in nests or hives or other preferred hiding places. Avoid wearing bright colored-clothing and perfumes or other fragrances if you will be in an area where these insects are known to gather.

Erickson TB, Márquez A. Arthropod envenomation and parasitism. In: Auerbach PS, Cushing TA, Harris NS, eds. Auerbach’s Wilderness Medicine. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 41.

Otten EJ. Venomous animal injuries. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 55.

Varney SM, Ahmed S. Bites and stings. In: Bakes KM, Buchanan JA, Moreira ME, Byyny R, Pons PT, eds. Emergency Medicine Secrets. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 73.

Last reviewed on: 7/20/2021

Reviewed by: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

What to do if a wasp or a bee has bitten? | Eternal questions | Question-Answer

07/12/2013 10:00

Maya Milic

Estimated reading time: 5 minutes

258669

Category:
First Aid

First steps

If you have been stung by a bee or wasp, the first thing to do is wash the sting site thoroughly, it is important to wash off all dirt and poison residues.

After that – carefully pull out the stinger so that the released poison does not spread. You can do this with your fingers or with tweezers, a knife or a needle. Remember that before the procedure, hands must be washed, and the instrument must be disinfected. Only bees leave a sting, so if you are bitten by a wasp, do not try to find the sting and do not pick the wound.

After pulling out the sting, it is necessary to disinfect the wound itself – for this you need alcohol, iodine, brilliant green, hydrogen peroxide, furacilin solution. You can wash the bite site with any antiseptic or even ordinary soap.
Once again, it is better not to touch the wound and the affected area of ​​​​the body, do not rub, and even more so do not comb.

Drink any antihistamine immediately after wound treatment , even if you have never had an allergic reaction to anything before.

Until the edema subsides, try to drink as much liquid as possible — hot sweet tea or sweet water. Victims of a wasp sting are advised to sit down or lie down.

Pain, redness and swelling usually disappear after a few hours or days. If a wasp stung in the face, then the swelling can last for about two days.

If the number of bites was more than three, then a general toxic reaction may begin. The most dangerous are bites on the lip, tongue or larynx – in this case, the edema that appears after the bite, spreading to the entire larynx, can lead to suffocation. In both cases, medical attention should be sought immediately.

bees. Photo: www.globallookpress.com

Handy tools

By the way

– A bee can sting only once in its life, it has a serrated sting that gets stuck in the layers of the skin and breaks off, which leads to the death of the bee. – Wasps, hornets and bumblebees can sting many times, as they have smooth stings. Wasps sting people much more often than bees. – A wasp sting is much more painful than a bee sting. – If a person is bitten by several dozen wasps at once, then a general toxic reaction of the body occurs. Bites of more than 500 individuals are considered fatal.

Folk remedies should be used if there are no medicines or disinfectants on hand. The bite site can be treated with parsley (mash the parsley leaf and lubricate the bite with juice) or rub with something sour that was at hand – sour berries, vinegar, citric acid.

Pain is relieved by dandelion milky juice.

Read on the topic: If a wasp has bitten, what should be applied to the stung place? >>

To relieve swelling, you can make lotions from tea, ice, aloe juice, onion, parsley, plantain. Also, a piece of sugar applied to the wound, a heating pad with cold water, an ice cube or a handkerchief previously moistened with cold water, and calendula tincture will help relieve swelling.

Advice for Allergy sufferers

It is believed that people in whom a wasp or bee sting can cause such a strong and life-threatening reaction are few – about 2 or 3%. But if you know that you are prone to allergic reactions, when going to nature, take antihistamines with you.

The general first steps after a wasp or bee sting should include applying a tourniquet above the sting. To prevent a decrease in blood pressure caused by urticaria, the victim can be given 25 drops of cordiamine.

In allergy sufferers, wasp or bee stings can cause dizziness, vomiting, diarrhea, anaphylactic shock (blood pressure drops sharply, laryngeal stenosis occurs, voice becomes hoarse), nausea, convulsions and even loss of consciousness. Therefore, without hesitation, seek medical help immediately after a bite and first aid.

Safety Rules

Bees and wasps generally only bite when they think they are being attacked, so it’s best not to wave your arms in front of them. If you are very afraid of these insects, you should buy a special aerosol that repels insects.

Read on:

How to protect yourself from bee stings? >>

How to get rid of wasps in the garden? >>

Tips for an allergic summer resident: what to do if a wasp stings? >>

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Bumblebee Bite & Allergy Treatment

Bumblebee Bite & Allergy Treatment

Provides information about bumblebee stings, tips to reduce the chance of being bitten, and information about possible reactions to the sting and treatment of the sting. You can download a poster about bumblebee stings and allergies here.

Bumblebee, honey bee and wasp stings

Bumblebees occur naturally in many countries. In addition, bumblebees and bees are used as pollinators on agricultural and horticultural crops. There are various subspecies with different appearances, including different colors and patterns. In general, bumblebees are larger than honey bees and have more hairs than wasps.

Only worker bumblebees and queens have a sting, as is the case with honey bees and wasps. Drones can’t sting. The sting is a defensive weapon. When a bee stings, poison is injected into the wound through the sting. In humans, this causes short-term sharp pain, which then passes. Sometimes (in about 1% of cases) an allergic reaction to the injected poison develops.
The reaction to a bumblebee sting can vary.

The bumblebee or wasp has no serrations on its stinger. This means that a working bumblebee or queen can pull out the stinger and apply it again. On the sting of the honey bee there are notches. When the honey bee tries to extract the sting, it bursts out of the abdomen along with the venom gland.

How to prevent bumblebee stings?

Bumblebees rarely sting. The chance of being stung by a bumblebee can be reduced by not provoking them or making them aggressive. First of all, it is important to remain calm while working with bumblebees. Don’t wave your arms around bumblebees, hit the hive, don’t touch or hold bumblebees, etc.

Be aware that bumblebees can react aggressively to odors such as alcohol, sweat, perfumes, scented soaps, aftershave, etc. In addition, rings, bracelets and watches can cause aggressive behavior (due to the smell of oxidation between the skin and jewelry). Bumblebees are attracted to the color blue, including blue and especially light blue clothing. Protective clothing can reduce the risk of being bitten. Bumblebees can sting through clothing.

Have you been stung? Bumblebee sting reaction

Usually a bumblebee sting results in a non-allergic local reaction of swelling, itching and redness at the site of the sting, lasting only a couple of hours. This can happen immediately after being bitten, but usually starts after a few hours. Swelling and itching may persist for hours or even days. In some cases, a local reaction may spread throughout the body; in this case, it may take longer for the symptoms to disappear. This is still considered a local, non-allergic reaction.

Measures to deal with non-allergic, local reactions

Usually no medical treatment required. Measures can be taken to minimize the local reaction, particularly if the bite affects a sensitive area, such as near the eyes. Anti-inflammatory drugs should be taken as soon as possible after the bite. A cold compress can be applied to the bite site. In addition, there are a number of antipruritic ointments (for example, containing diethyl-m-toluamide).

In rare cases where the bite is in the mouth or throat, the victim should be taken to hospital immediately because this can lead to airway asphyxia. At the hospital, the patient will be given corticosteroids and kept under observation.

Allergic reaction

In about 1% of the population, multiple bumblebee stings (or in some cases as few as two or three stings) can lead to an allergic reaction, also called a generalized allergic reaction, a systemic allergic reaction, or an anaphylactic reaction. Since antibodies formed during previous exposure to the antigen are involved in the allergic reaction, it is not possible to develop an allergic reaction after the first bite. An allergic reaction usually occurs very soon after the bite (from a few seconds to half an hour after the bite).

Allergic reactions are divided into four levels in order of increasing severity:
Grade 1 – Itching, redness and swelling (urticaria, rash) all over the body
Grade 2 – Grade 1 symptoms and bowel problems (vomiting, diarrhea
Grade 3 – Grade 1 and/or 2 symptoms and difficulty breathing and/or choking
Grade 4 – Grade 1 and/or 2 and/or 3 symptoms and palpitations, fainting, anaphylactic shock (accompanied by dizziness, excessive sweating and chills)

Allergic Reaction Measures

If you have a fever or level 1 reaction, seek medical attention. It may be necessary to follow the development of the situation. It is advisable to observe the victim in the hospital for some time, as the reaction may progress over time.

In the event of vomiting, and certainly with Grade 3 or 4 symptoms, the victim should be taken to hospital immediately.
If an allergic reaction occurs, it is useful to use an antihistamine. The antihistamine reduces tumors caused by the histamine in the venom. Sometimes corticosteroids may be prescribed. In the case of reactions of 3 or 4 degrees, adrenaline must first be administered. Adrenaline stimulates the heart, constricts blood vessels and opens the airways. Adrenaline auto-injectors are sold by prescription only, for example, if the patient has already had an allergic reaction to a bumblebee sting. Depending on local regulations, an epinephrine auto-injector may also be available from companies that work with bumblebees.

Toxic reactions

Toxic reactions only occur if the victim has been stung dozens of times in a short period. General allergic reactions may occur in the nervous or circulatory system, such as cardiac arrhythmias or breathing difficulties. In this case, the victim should be taken to the hospital for treatment and observation.

Hyperventilation

In addition to a severe grade 4 allergic reaction, hyperventilation resulting from shock can also lead to unconsciousness. In such cases, it is also necessary to immediately call for emergency medical care.

Increased risk

People who use certain medications (beta-blockers) and pregnant women are at increased risk for allergic reactions after a bumblebee sting.

Bumblebee Allergy

If you’ve had an allergic reaction in the past, it won’t necessarily happen the next time you bite. The chances are especially slim if you’ve had a Grade 1 or 2 reaction. The reaction to bumblebee stings can vary from case to case. Currently, a test using purified bumblebee venom can be done to determine if you will have an allergic reaction the next time you are stung. You can also use purified poison to reduce sensitivity.

Bee venom immunotherapy does not necessarily protect patients from bumblebee sting allergy. This treatment is intended to reduce susceptibility to bumblebee venom. If you don’t want to be treated for desensitization, you can get a prescription for an adrenaline auto-injector from your doctor. It can be carried around and used to inject epinephrine into the thigh in case of a bite.

Information for Physicians

Detailed information on measures to manage allergic reactions is available from Koppert upon request.
Ask your allergist or GP for more information.

Literature

A printed poster with illustrations can be ordered from Koppert. This poster is also available for download (URL).
Tip: Put on the poster the contact information for a doctor or emergency call.

This information is provided for educational purposes only and should not be used to diagnose or treat health problems as it is not a substitute for medical care.