Insect bites and stings - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Insect bites and stings can lead to reactions ranging from local irritation and mild swelling, through to dangerous anaphylaxis with unconsciousness and respiratory distress.
Treatment for local reactions is usually entirely supportive, aimed at alleviating discomfort and swelling. Severe reactions and anaphylaxis require immediate intervention to maintain airway patency and prevent cardiovascular collapse. Epinephrine (adrenaline) is the mainstay treatment of severe reactions, and intravenous fluids may also be needed.
Fatal spider bites are exceedingly rare. Most spider bites can be treated with supportive care.
There is a risk of late-phase (delayed) local swelling that can be significant and may show lymphangitic streaks. Anaphylactic reactions begin within 20-40 minutes in the great majority of cases, but a few reactions are delayed in onset, and there is risk of biphasic anaphylaxis following an initial anaphylactic reaction.
Primary care physicians should be notified of severe reactions involving their patients.

Honeybee stinging flesh

Courtesy of Rick Vetter

Quick Reference

History & Exam
- Key Factors
- Other Factors
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Diagnostics Tests
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Treatment Options
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Definition

Epidemiology

Etiology

Pathophysiology

Images

Honeybee stinging flesh
Close-up of honeybee stinger
Black widow (Latrodectus species); the red hourglass marking is not always this shape and may not be present
Brown recluse spider (Loxosceles species); note the violin shape darker coloration on cephalothorax and 3 pairs of eyes at the base of the violin
Yellow jacket
Honeybee stinger anatomy
Black widow (Latrodectus species)
Black widow (Latrodectus species)
Brown recluse spider (Loxosceles species); note violin shape darker coloration on cephalothorax and 3 pairs of eyes at the base of the violin
Brown recluse spider (Loxosceles species)
Periorbital swelling 24 hours after yellow jacket sting above right eye
Wheal formation following wasp sting
Pseudopustule formation following fire ant sting
Lesions from reported brown recluse (Loxosceles species) envenomation
Lesions from reported brown recluse (Loxosceles species) envenomation
Erythema migrans of Lyme disease

Citations

Key Articles

Shaker MS, Wallace DV, Golden DBK, et al. Anaphylaxis - a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis. J Allergy Clin Immunol. 2020 Apr;145(4):1082-123.[Abstract][Full Text]
Golden DBK, Wang J, Waserman S, et al. Anaphylaxis: a 2023 practice parameter update. Ann Allergy Asthma Immunol. 2024 Feb;132(2):124-76.[Abstract][Full Text]
Golden DB, Demain J, Freeman T, et al. Stinging insect hypersensitivity: a practice parameter update 2016. Ann Allergy Asthma Immunol. 2017 Jan;118(1):28-54.[Abstract]
Sturm GJ, Varga EM, Roberts G, et al. EAACI guidelines on allergen immunotherapy: Hymenoptera venom allergy. Allergy. 2018 Apr;73(4):744-64.[Abstract][Full Text]
Biló BM, Rueff F, Mosbech H, et al. Diagnosis of Hymenoptera venom allergy. Allergy. 2005 Nov;60(11):1339-49.[Abstract][Full Text]

Other Online Resources

CDC: insects and scorpions

Referenced Articles

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