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Insect bites and stings

Also listed as: Bites and stings - insect; Stings and bites - insect

• Signs and Symptoms
• Causes
• Treatment Approach
• Supporting Research

Insect bites or stings can be from a host of agents including bees, spiders, fleas, hornets, wasps, and mosquitoes. Some cause itching; others cause pain. And if you are allergic, a reaction can be very severe including anaphylaxis – a response that leads to shortness of breath and tightening of your throat. This is a medical emergency and 911 should be called. Another common allergic reaction is called angioedema which involves swelling throughout your body, especially the face, lips, and around your eyes. More people have allergic reactions to stinging insects than to biting insects.

Signs and Symptoms

• Red, swollen, warm lump
• Hives
• Itching, tenderness, pain
• Sores from scratching; can become infected
• Serious allergic reactions when symptoms spread (this is called anaphylaxis). These can include difficulty breathing, dizziness, nausea, diarrhea, fever, muscle spasms, or loss of consciousness. Call for emergency medical help right away.

Causes

Stinging insects include bumblebees, yellow jackets, hornets, wasps, and fire and harvester ants. Biting insects include conenose bugs, mosquitoes, horseflies, deerflies, spiders, bedbugs, and black flies.

Prevention

• Try not to provoke insects. For example, avoid rapid, jerky movements around insect hives or nests.
• Avoid perfumes and floral-patterned or dark clothing.
• Use appropriate insect repellants and protective clothing. (See more details below.)
• Exercise caution when eating outdoors, especially with sweetened beverages or in areas near garbage cans.

If you know that you have a serious allergy to an insect, carry an emergency ephinephrine kit. Your doctor can prescribe. Make sure that friends and family members know how to use the Epi-pen if you have had a reaction in the past. Wear a medical ID bracelet.

Proper clothing is very important for avoiding insect bites or stings. The following tips may help you remember some important practices:

• Don't forget to cover your head. Using a full brimmed hat will help shield your neck as well.
• Tuck pant cuffs into socks. This helps protect your ankles – a common spot for bites or stings.
• Check your clothes periodically for bugs.
• Use protective netting when sleeping outdoors. Such equipment is available for outdoor eating activities as well.

Applying insect repellent to clothing can help avoid skin irritation. When in an area infested with mosquitoes, sand flies, or ticks, use chemical insect repellent such as DEET. (Lower concentrations of DEET should be used in pregnant women and small children.) Avoid use of insect repellent on sunburned skin. When applying both sunscreen and bug repellent, apply the sunscreen first. Wait 30 minutes before applying the bug repellent.

DO NOT use bug repellent on children's hands because of the chance they may rub their eyes or put their hands in their mouths. NEVER inhale or ingest insect repellent.

Treatment Approach

In most cases, bites and stings can be easily treated at home, except in the case of a severe allergic reaction like anaphylaxis, which can be fatal if not treated IMMEDIATELY. If such an emergency occurs:

• Check the person's airway, breathing, and pulse. If necessary begin rescue breathing and CPR and call 911.
• Use the person's Epinepherine pen or other emergency kit if they have one. (Anyone who has had a serious allergic reaction to an insect sting should carry an Epi-pen or its equivalent at all times.)
• Try to keep the person calm.
• Remove nearby rings and other constrictinng items in case of swelling.
• Stay with the person until medical help arrives.

For non-emergency bites or stings, see Lifestyle section.

Lifestyle

Local reactions of redness, minor swelling, pain or itching at the site of the bite generally go away in three to seven days with no treatment, even if the effected area is large. To relieve your symptoms, follow these steps:

• Remove the stinger if it is still present by scraping the back of a knife or other straight-edged object across the stinger. DO NOT use tweezers. These may squeeze the venom sac and increase the amount of venom released. This would worsen the local swelling and pain.
• Wash thoroughly with soap and water to avoid infection. Watch for signs of infection over the next several days like increased redness or red streaking along your skin.
• Place an ice pack, wet compress, or ice wrapped in a cloth on the site for 10 minutes two times (that is, 10 minutes on, 10 minutes off, and then 10 minutes on again) to reduce swelling.
• Take an antihistamine or apply a cream that reduces itching (like Calamine or Benadryl ointment) if you can't control the temptation to scratch.

Medications

• Antihistamines may be recommended for itching and swelling.
• Antibiotics may be prescribed by your health care provider if infection is present.
• If the reaction is serious enough that a hospital visit is warranted, anithistamines may be given intravenously and epinepherine (adrenaline) may be administered.

Nutrition and Dietary Supplements

Incorporating certain nutrients into your diet, through foods or supplements, may in theory reduce inflammation or an allergic reaction from insect bites or stings. These nutrients would need to be part of your diet on an ongoing basis. Then, when exposed to an insect bite or sting, your reaction may be less intense. Talk to your doctor before taking nutritional supplements to make sure that it is safe for you and that the particular substance will not interact with any medications that you regularly take. Examples of such nutrients include:

Bromelain

Bromelain ( Ananas comosus , an enzyme derived from pineapple)—topical use recommended by some clinicians to help reduce swelling from insect bites or stings; turmeric ( Curcuma longa ) may enhance the effects of bromelain.

Omega-3 Essential Fatty Acids

Omega-3 essential fatty acids have anti-inflammatory properties that may help protect against the extreme reaction of anaphylaxis and other allergic responses. There was a lower death rate from anaphylactic shock in animals on a high omega-3 fatty acid diet compared to those on a high omega-6 diet. How this translates to people is not known at this time.

Quercetin & Other Flavonoids

Naturopathic doctors often recommend that people with known allergies take quercetin (a naturally occurring flavonoid) before being exposed to the offending agent (like a particular insect). This should lessen the severity of the allergic response. If you have a history of an allergy to bees, wasps, or other insects, you might want to consider taking quercetin supplements or eating foods high in flavonoids (such as fruits and vegetables) on a regular basis. Animal studies appear to support this traditional use of quercetin. If you are sensitive to citrus or take calcium-channel blockers to treat high blood pressure, you should avoid citrus-based forms of flavonoids. Vitamin C may enhance the effects of quercetin.

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, contain active substances that can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care and ONLY under the supervision of a practitioner knowledgeable in the field of herbal medicine. Also, BE SURE to talk to your doctor about any herbs that you are considering.

Some herbs that have been used topically by naturopaths or other herbal specialists to reduce symptoms from insect bites or stings include:

• Arnica ( Arnica montana ) , a remedy commonly used in homeopathic doses, has been used as a topical herb for inflammation from insect bites. Talk to an herbal specialist about how to safely do so.
• Lemon balm ( Melissa officinalis ) – traditional treatment for relief of insect bites or stings.
• Stinging nettle   ( Urtica dioica ; Urtica urens ) - Applying juice from the stinging nettle to the skin may relieve pain from insect bites.
• Turmeric ( Curcuma longa ) - strengthens the effects of bromelain. The oil of turmeric may also work as a natural bug repellent in combination with citronella and other essential oils. Talk to a naturopath or other qualified, trained herbal specialist about how to use essential oils as bug repellants. Eucalyptus, lavender, lemongrass, pennyroyal, and hairy basil are amongst the additional oils, along with extracts of vanilla bean, that such a professional might consider and teach you to appropriately make and use.

Homeopathy

There have been few studies examining the effectiveness of specific homeopathic remedies. A professional homeopath, however, may recommend one or more of the following treatments for insect bites and stings based on his or her knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual and might select from amongst the following treatments for an insect bite or sting:

• Apis mellifica — for stinging pains with rapid swelling and affected area that is warm to the touch; this remedy is most appropriate for individuals who feel better with cold applications; Apis is recommended if hives are present or if Ledum does not reduce pain or swelling after 4 hours
• Hypericum — for bites accompanied by sharp, shooting pains that often occur in sensitive areas, such as at the ends of fingers or toes
• Ledum — most commonly used homeopathic agent for bites and stings from bees, mosquitoes, wasps, or spiders; affected area is cold to the touch but cold applications or immersion in cold water improves symptoms
• Staphysagria — for children with large, itchy mosquito bites that may create large welts
• Urtica urens — for red, swollen bites with itching and stinging; may be used instead of Apis to treat hives

Supporting Research

Blumenthal M, Goldberg A, Brinckmann J, eds. Herbal Medicine: Expanded Commission E Monographs . Newton, Mass: Integrative Medicine Communications; 2000; 230-232, 379-384.

Bromelain. Alt Med Rev . August 1998;3:302–305.

Cavanagh HM, Wilkinson JM> Biological activities of lavender essential oil. Phytother Res. 2002;16(4):301-308.

Conforti A, Bertani S, Metelmann H, Chirumbolo S, Lussignoli S, Bellavite P. Experimental studies of the anti-inflammatory activity of a homeopathic preparation. BiolTher . 1997;15(1):28-31.

Coverman MH. Alternative therapies for acne, aphthae, insect bites, and callous diseases. Cermatol Clin . 1989;7(1):71-72.

Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines . 3rd ed. New York, NY: Penguin Putnam; 1997: 301-302.

Curcuma longa (turmeric). Monograph. Altern Med Rev . 2001;6 Suppl:S62-S66.

Hill N, Stam C, Tuinder S, van Haselen RA. A placebo controlled clinical trial investigating the efficacy of a homeopathic after-bite gel in reducing mosquito bite induced erythema. Eur J Clin Pharmacol. 1995;49(1-2):103-108.

Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide . New York, NY: Warner Books; 1996: 146.

Kruzel T. The Homeopathic Emergency Guide . Berkeley, Calif: North Atlantic Books; 1992:198-200.

Lukwa N, Molgaard P, Mutambu SL, Musana BJ. Seven essential oils inhibit Anopheles arabiensis mosquito biting. Cent Afr J Med . 2002;48(11-12):141-143.

Oyedele AO, Gbolade AA, Sosan MB, Adewoyin FB, Soyelu OL, Orafidiya OO. Formulation of an effective mosquito-repellent topical product from lemongrass oil. Phytomedicine . 2002;9(3):259-262.

Pitasawat B, Choochote W, Tuetun B, et al. Repellency of aromatic turmeric Curcuma aromatica under laboratory and field conditions. J Vector Ecol . 2003;28(2):234-240.

Taussig SJ, Batkin S. Bromelain, the enzyme complex of pineapple (Ananas comosus) and its clinical application. An update. J Ethnopharmacol . 1998;22:191–203.

Tawatsin A, Wratten SD, Scott RR, Thavara U, Techadamrongsin Y. Repellency of volatile oils from plants against three mosquito vectors. J Vector Ecol . 2001;26(1):76-82.

Ullman D. Homeopathic Medicine for Children and Infants . New York, NY: Penguin Putnam; 1992: 52.

• Review Date: 4/1/2004
• Reviewed By: Participants in the review process include: Shiva Barton, ND, Wellspace, Cambridge, MA; Jacqueline A. Hart, M.D., Department of Internal Medicine, Newton-Wellesley Hospital, Newton, Ma., and Senior Medical Editor, A.D.A.M., Inc.; Leonard Wisneski, MD, FACP, George Washington University, Rockville, MD; Terry Yochum, DC, Rocky Mountain Chiropractic Center, Arvada, CO.

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