Insect Sting and Bite Management

Initial Treatment

Remove the stinger by flicking or scraping (not squeezing) within 10-20 seconds to prevent further envenoming and reduce the risk of systemic symptoms, as recommended by the American Academy of Allergy, Asthma, and Immunology and the American Heart Association (Class 2a recommendation) 1, 2
Clean the area by washing with soap and water to prevent secondary infection 1, 2
Apply cold compresses to reduce local pain and swelling, as recommended by the American Academy of Allergy, Asthma, and Immunology 1
Administer age-appropriate doses of antihistamines for symptom relief, as recommended by the American Academy of Allergy, Asthma, and Immunology 1

Administer epinephrine immediately if available (0.01mg/kg, up to 0.3mg for children, and 0.3-0.5mg intramuscularly in the anterolateral thigh for adults) as the first-line treatment for anaphylaxis, as recommended by the American Academy of Allergy, Asthma, and Immunology 1
Use over-the-counter acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief, as recommended by the American College of Cardiology (Class 2a recommendation) 2
Apply ice for local pain relief, as recommended by the American College of Cardiology (Class 2a recommendation) 2
Topical lidocaine may help relieve local pain if the skin is intact, as recommended by the American College of Cardiology (Class 2a recommendation) 2

Antibiotics are usually unnecessary for simple insect bites unless there are signs of infection, as stated by the American Academy of Allergy, Asthma, and Immunology 1
First-line antibiotic options for infected insect bites include:
Monitor the sting site for 48-72 hours for signs of infection or delayed reaction, as recommended by the American Academy of Allergy, Asthma, and Immunology and the Infectious Diseases Society of America 1, 3

Referral is recommended for patients who have experienced a systemic allergic reaction to an insect sting, need education about risk of future reactions, emergency treatment options, and insect avoidance, or might be candidates for venom immunotherapy (VIT), as suggested by the American Academy of Allergy, Asthma, and Immunology 1
Patients with coexisting conditions that might complicate treatment of anaphylaxis should also be referred for specialized care, as recommended by the American College of Allergy, Asthma, and Immunology 1
Consider referral to an allergist-immunologist if there is a history of severe reactions to insect stings, as recommended by the American Academy of Allergy, Asthma, and Immunology 1

Avoid tick-infested areas and use protective clothing to prevent tick bites, and use age-appropriate insect repellents, with DEET concentrations of 10-30% considered safe for children, and no greater than 20-30% as recommended by the American Academy of Pediatrics 7, 8
Perform regular tick checks after outdoor activities, and dress children in light-colored clothing to easily spot ticks, as recommended by the American Academy of Pediatrics 7, 8
Have known or suspected nests removed by trained professionals, and be cautious near areas where insects are commonly found, such as bushes, eaves, attics, garbage containers, and picnic areas, as recommended by the American Academy of Allergy, Asthma, and Immunology 1