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Honeybee sting in Adult
Other Resources UpToDate PubMed

Honeybee sting in Adult

Contributors: Robert Norris MD, Joanne Feldman MD, MS
Other Resources UpToDate PubMed


There are 7 species of honeybees. They are native to Europe, Asia, and Africa but have been imported and domesticated in other countries. When domesticated, they live in man-made hives in large colonies where they are used to produce honey and pollinate fruits, vegetables, and seed crops. Honeybees are not aggressive but will sting to defend their nests if disturbed. Africanized honeybees, unlike most honeybees, are very aggressive and will swarm and sting with the slightest disturbance (see Africanized bee sting).

Honeybees sting defensively. The barbed stinger separates from the abdomen allowing the venom to continue to pump into the wound while alarm pheromones are released to attract other bees. The principal components of honeybee venom include the peptides melitin, mast cell degranulating peptide, apamin, and adolapin. Melitin, a strongly basic peptide, damages cell membranes and is responsible for the pain associated with the sting. Mast cell degranulating peptide causes histamine release and an inflammatory reaction. Apamin is a neurotoxin that acts principally on the spinal cord, and adolapin has anti-inflammatory activity. The two main enzymes are phospholipase A and hyaluronidase. Phospholipase A and melitin are thought to be the major venom allergens and account for much of the acute lethality.

The lethal dose of honeybee venom is approximately 15 stings/kg. However, one sting in a sensitized person can be fatal due to anaphylaxis. Most deaths related to honeybee stings (with the exception of Africanized honeybees) are due to anaphylaxis.

Four possible reactions are seen after a honeybee sting: local reactions, regional reactions, anaphylaxis and, rarely, delayed-type hypersensitivity. In addition, multiple stings can cause systemic envenomation and death from direct venom toxicity.

Local sting reactions include immediate pain, swelling, and redness at the sting site that often subsides within a few hours.

Regional reactions (exaggerated local reactions) occur in some individuals with extended swelling that can last 2-7 days. These reactions are not allergic in origin.

Anaphylactic reactions cause diffuse urticaria, pruritus, angioedema, bronchoconstriction, respiratory distress, hypotension, loss of consciousness, and cardiac arrhythmias. Onset of life-threatening, anaphylactic signs typically occur within 10 minutes of the sting but can be delayed in onset for hours.

Delayed-type hypersensitivity can manifest as serum sickness, vasculitis, neuritis, encephalitis, nephritis, and coagulation defects.

Systemic envenomation from multiple stings may cause vomiting, diarrhea, generalized edema, dyspnea, hypotension, tachycardia, acute myocardial infarction, atrial fibrillation, cardiovascular collapse, and cerebral infarction. Widespread necrosis of skeletal muscle with hyperkalemia, acute tubular necrosis with renal failure, hepatorenal syndrome with hemolysis, acute pancreatitis, and disseminated intravascular coagulation have been reported.


T63.441A – Toxic effect of venom of bees, accidental, initial encounter

89910002 – Poisoning by honey bee sting

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Last Updated:02/21/2018
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Patient Information for Honeybee sting in Adult
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Contributors: Medical staff writer


Bites or stings from insects (arthropods) are very common. Most reactions are mild and result from an allergic reaction to either the insect or the toxins injected with the bite or sting. Some people have severe reactions to the stings of:
  • Bees
  • Wasps
  • Hornets
  • Yellow jackets
These stings may require emergency help. The bites of most insects – such as ants, mosquitoes, flies, spiders, ticks, bugs, and mites – do not cause such a severe reaction.

Sometimes, it may be hard to tell which type of insect has caused the skin lesions, as many insect reactions are similar. Flying insects tend to hit exposed skin areas, while bugs such as fleas tend to hit the lower legs and around the waist, and often have several bites grouped together. Some individuals are far more sensitive to insects and have more severe reactions, so the fact that no one else in the family has lesions does not rule out an insect bite.

Who’s At Risk

Insect bites and stings are a problem in all regions of the world for people of all ages. In the Midwest and East Coast regions of the US, mosquitoes, flying insects, and ticks account for most bites. In drier areas of the Western US, crawling insects are more of a problem.

There is no proven effect of race or sex in terms of bite reactions. However, some individuals clearly appear more attractive to insects, perhaps related to body heat, odor, or carbon dioxide excretion.

Severe allergic reactions to stings occur in .5–5% of the US population.

Signs & Symptoms

Honeybee stings cause immediate pain, redness, and swelling at the sting site. These symptoms usually last for a few hours.

Flying insects tend to choose exposed areas not covered by clothing.

Common reactions to stings include:
  • Redness, pain, and swelling
  • Severe reactions such as facial swelling, difficulty breathing, and shock (anaphylaxis)
  • Fever, hives, and painful joints (though these reactions are not as common)

Self-Care Guidelines

  • Bees may leave a stinger behind. Try to gently scrape off the stinger with a blunt object, such as a credit card.
  • Wash the wound with soap and water.
  • Apply an ice pack or cold water for a few minutes.
  • Take acetaminophen for pain and an antihistamine (diphenhydramine or chlorpheniramine) for itching, as needed.

When to Seek Medical Care

When dealing with stings, be sure to watch out for symptoms such as:
  • Hives, itching, or swelling in areas beyond the sting site
  • Swelling of the lips or throat
  • Tightness in the chest or difficulty breathing
  • Hoarse voice or tongue swelling
  • Dizziness or loss of consciousness


Depending upon your reaction to the sting, your primary care giver might treat you in the following manner:
  • Antihistamines or corticosteroids
  • Epinephrine, antihistamines, corticosteroids, intravenous fluids, and oxygen (for anaphylaxis)
  • Injectable epinephrine, for those with known severe allergic reactions
  • Immunotherapy to reduce the chance of repeated severe reactions
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Honeybee sting in Adult
A medical illustration showing key findings of Honeybee sting : Edema, Red color, Painful skin lesion
Clinical image of Honeybee sting - imageId=2030222. Click to open in gallery.  caption: 'Marked edema and erythema of the upper eyelid.'
Marked edema and erythema of the upper eyelid.
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