How Do You Know If You Are Allergic to Bee Stings?

Know what is normal. The USDA Agricultural Research Service says a normal reaction to a honey bee sting may include swelling or redness around the sting and a feeling of heat or itchiness, that swelling can sometimes be severe, such as an arm swelling up to the elbow after a finger sting, and that this is fairly common and normal swelling may last up to a few days.

Anaphylaxis is different. The Agricultural Research Service says anaphylactic reactions include swelling of the mouth or throat, shortness of breath, difficulty swallowing and shock, typically occur within minutes or even seconds, are very rare, affecting an estimated less than 1 percent of the population, and require immediate medical attention. The FDA describes anaphylaxis as a severe, life-threatening allergic reaction and medical emergency that insect stings can trigger, with symptoms such as hives, swelling, itching, vomiting, difficulty breathing and loss of consciousness, and says epinephrine is the only life-saving treatment. NIOSH warns that workers allergic to insect venom could die from anaphylactic shock, which requires immediate emergency care.

After a bee, wasp or hornet sting, NIOSH advises having someone stay with the person to see if they have an allergic reaction, washing the site with soap and water, removing the stinger by wiping gauze or scraping a fingernail over the area without squeezing it or using tweezers, and applying ice to reduce swelling.

The Agricultural Research Service says anaphylaxis treated in time usually can be reversed by injected epinephrine, and that people who know they are allergic to stings should carry epinephrine, which is obtainable only by prescription, whenever they may encounter stinging insects. In August 2024 the FDA approved neffy, a single-dose epinephrine nasal spray, noting that a second dose may be given if symptoms do not improve or worsen and that patients may still need emergency medical care. A 2023 German allergy society guideline says a high percentage of patients can be protected from recurrent systemic sting reactions, at least for the duration of venom immunotherapy.