Management of Bee Stings

Treatment Approach

Topical corticosteroids are the recommended steroid formulation for treating local itching and inflammation from bee stings, with oral corticosteroids reserved only for severe large local reactions with extensive swelling 1, 2
Apply topical corticosteroids directly to the sting site to alleviate local itching and reduce inflammation 1, 2
Combine topical corticosteroids with cold compresses and oral antihistamines for optimal symptom control 3, 4
Over-the-counter acetaminophen or NSAIDs may be added for pain relief 1
Antibiotics are NOT indicated - the swelling is allergic inflammation, not infection 3, 5

A short course of oral corticosteroids is effective for limiting severe swelling, particularly when started promptly within the first 24-48 hours 3
The American Academy of Allergy, Asthma, and Immunology supports oral corticosteroids for severe cases, though acknowledging limited controlled trial data 3, 5

Epinephrine is the primary treatment for anaphylaxis (difficulty breathing, throat swelling, lightheadedness, widespread hives), NOT corticosteroids 1, 2, 4
Corticosteroids play NO role in acute anaphylaxis management - epinephrine must be administered immediately 3, 4

Remove the stinger immediately by scraping or plucking, as venom delivery continues for up to 60 seconds - this takes priority over any medication administration for local reactions 1, 6
For large local reactions, prompt initiation of oral corticosteroids within the first day or two is most effective at limiting progression of swelling 3, 5