by John Marsh
As I chatted with my buddy J.C. on a recent ride, I felt the telltale pinpoint sharp pain on the front of my left ankle. Even though I had not seen it, I knew immediately what had just happened — bee sting.
I told J.C. and looked for the nearest place to pull over. As he held my bike, I reached down and slowly pulled down my sock. Sure enough, there was the bright red sting site — and the stinger still stuck in my sock.
We were at least 15 miles away from home, so I was not able to do anything immediately to deal with the effects of the sting. However, I knew I wasn’t one of the approximately 3 percent of the population that can suffer a severe allergic reaction (anaphylaxis) to a bee sting, so I wasn’t overly concerned.
Still, even for the rest of us, bee stings while riding are an unfortunate, largely unavoidable, and nearly inevitable nuisance at the very least. At worst, they can cause extreme swelling and discomfort. Because they happen more often than we would like, and are potentially dangerous, it’s helpful for all riders to refresh our memory on what to do if we’re stung.
Stings Fall Into 3 Categories
By the time I got home, the venom had spread to an area the size of a softball. The sting site was still painful, and the surrounding red area was starting to itch. But there was no sign of swelling (that would come overnight, leaving my ankle grossly inflated and causing me worry about the mountain century I was riding only 2 days later).
I quickly looked up “bee sting” on the MayoClinic.com website, just to double-check my instincts and memory about the proper treatment. Heaven knows my memory is not what it used to be!
Here’s what I found.
First, bee stings typically fall into one of three categories, based on the severity of the reaction to the sting, including a host of escalating symptoms. The following is from www.mayoclinic.com:
Most of the time, signs and symptoms of a bee sting are minor and 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.
Large local reaction
About 10 percent of people who get stung by a bee or other insect have a bit stronger reaction (large local reaction), with signs and symptoms such as:
- Extreme redness
- Swelling at the site of the sting that gradually enlarges over the next day or two
Large local reactions tend to resolve over five to 10 days. Having a large local reaction doesn’t mean you’ll have a severe allergic reaction the next time you’re stung. But some people develop similar large local reactions each time they’re stung. If this happens to you, talk to your doctor about treatment and prevention.
Severe allergic reaction (anaphylaxis)
A severe allergic reaction (anaphylaxis) to bee stings is potentially life-threatening and requires emergency treatment. About 3 percent of people who are stung by a bee or other insect quickly develop anaphylaxis. Signs and symptoms of anaphylaxis 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
- A weak and rapid pulse
- Nausea, vomiting or diarrhea
- Dizziness or fainting
- Loss of consciousness
People who have a severe allergic reaction to a bee sting have a 30 to 60 percent chance of anaphylaxis the next time they’re stung. Talk to your doctor or an allergy specialist about prevention measures such as immunotherapy to avoid a similar reaction in case you get stung again.
Treatment Options Based on Severity
The treatment protocols for a bee sting follow the 3 levels of severity as well. Here’s what the Mayoclinic.com site says about treatment options:
Treatment for minor reactions
When a bee stings, it jabs a barbed stinger into the skin. Removing the stinger and its attached venom sac right away will keep more venom from being released.
- Remove the stinger as soon as you can, as it takes only seconds for all of the venom to enter your body. Scrape the stinger out with the edge of a credit card or 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.
- Apply cold compresses to relieve pain and ease swelling.
Treatment for large local reactions
The following steps may help ease the swelling and itching often associated with large local reactions:
- Remove the stinger as soon as possible.
- Wash the area with soap and water.
- Apply cold compresses.
- Apply hydrocortisone cream or calamine lotion to ease redness, itching or swelling.
- If itching or swelling is bothersome, take an oral antihistamine that contains diphenhydramine (Benadryl) or chlorpheniramine (Chlor-Trimeton).
- Avoid scratching the sting area. This will worsen itching and swelling — and increase your risk of infection.
Emergency treatment for allergic reactions
During an anaphylactic attack, an emergency medical team may perform cardiopulmonary resuscitation (CPR) if you stop breathing or your heart stops beating. You may be given medications including:
- Epinephrine (adrenaline) to reduce your body’s allergic response
- Oxygen, to help compensate for restricted breathing
- Intravenous (IV) antihistamines and cortisone to reduce inflammation of your air passages and improve breathing
- A beta agonist (such as albuterol) to relieve breathing symptoms
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. 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.
Bee stings are serious business. I have a good friend who commutes daily who falls into the last category. He’s carried an EpiPen ever since he ended up unconscious in a ditch on one morning commute following a sting. He never knew he was allergic until then.
The photo is of our own Jim Langley (utterly unrecognizable!), who was stung the day before he left on the 9-hour drive to Masters Nationals. He got stung above his sunglasses, on his forehead. The results speak for themselves. He iced his face on the drive, and the swelling subsided enough for him to compete. (That sting explains why Jim is so keen on helmets with face shields!)
As for me, I followed the treatment suggestions for a large local reaction to a T — icing my ankle and foot a 2-3 times a day, taking Ibuprofen and Benadryl, and applying a topical hydrocortisone creme.(I stopped taking the Benadryl for a full day before my ride, though, as I didn’t want to risk dehydration.) I took a test spin the day before Six Gap, with my ankle and foot still bulging against my shoe — straps greatly loosened. My ankle felt fine, though, and the swelling continued to decrease overnight. I rode fine, even setting a PR for the event.
Richard McClary says
Several years ago, Jonathan Vaughters was stung near the eye on a stage of the Tour de France. That eye swelled shut. The officials would not grant him an emergency exeption in order to let him use both eyes, so he had to withdraw from the race.
Frank A says
I recently, was stung by a bee while cycling. At a rest stop, I removed the stinger and took two Benadryl. Ten minutes later, while pedaling along, without warning, I passed out! I never before, had a reaction to Benadryl. My injuries were not too bad but, I will never take Benadryl and ride my bike at the same time again!.The bee sting my also have been a factor in the passing out but I will play it safe if there is ever a next time.
Doug Ford says
One diphenhydramine (Benadryl) should have been enough for anyone that isn’t severely allergic.
I keep a few sealed up in their blister packs with me on every ride, just in case someone else gets stung.
Barb A says
My husband was stung on his tongue. He went to an emergency department where they gave him an anti-histamine and kept him under observation. Fortunately he was OK. Imagine if he’d been miles from anywhere – his tongue could have swelled and blocked his airway.
Jill K says
How about a section in this article, or another, about what to do on a ride when ice and benadryl is not near to hand? There’s a lot of old wives’ tales about putting mud on the sting, or wet leaves, etc. What will work until we can get to our freezer and medicine cabinet?
Steven Koester, M.D. says
Good article and I generally agree but over the course of my career and seeing many bee reactions in my experience, and I think the opinion of most allergists, is that local reactions are a nuisance but not dangerous and are treated symptomatically. Treatments do not seem to alter the speed of recovery much. Ice is a local anesthetic and will make it feel better, and, of course, ibuprofen will help with discomfort and an antihistamine is helpful with itching but can cause sedation, especially diphenhydramine.
On the other hand, an anaphylactic reaction [throat or neck swelling and difficulty breathing] is a life threatening emergency. Epinephrine needs to be injected as soon as possible via EpiPen or a by first responder. If there is a delay in treatment, taking 50 mg diphenhydramine orally immediately can be life saving at times.
Will Haltiwanger says
I have begun to have significant swelling following stings. Recent wasp sing to my hand caused swelling above the elbow within 24 hours. I now carry Predisone with me on bike tours or other travel.