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Toxicology – Hymenoptera Envenomation (Bees, Wasps, Hornets)
Source
Hymenoptera are winged insects that include bees, wasps, hornets, and ants. The Vespidae family (wasps, yellow jackets, hornets) tend to be more aggressive, while the Apidae family (honeybees, bumblebees) are generally less aggressive unless provoked.
Typical Presentation
Patients may present after one or multiple stings, often occurring outdoors. Severe reactions are more likely in cases of multiple stings or in individuals with allergic sensitivity.
Clinical Features
Local reactions include pain, redness, swelling, and warmth at the sting site. Systemic reactions may involve widespread hives (urticaria), wheezing, shortness of breath, chest discomfort, nausea, vomiting, airway swelling (stridor), altered mental status, and in severe cases, shock or coagulopathy. Anaphylaxis can occur even after a single sting in sensitized individuals.
Mechanism of Action
Venom from these insects contains substances such as melittin, histamine, phospholipases, and other mediators that trigger inflammation and mast cell activation. This can lead to allergic reactions ranging from mild to life-threatening.
Management
Treatment is supportive. Any retained stingers should be promptly removed by scraping to prevent further venom release. Anaphylaxis requires immediate administration of epinephrine. Additional therapies may include antihistamines, corticosteroids, intravenous fluids, and inhaled beta-agonists for respiratory symptoms.
Key Points
Source
Hymenoptera are winged insects that include bees, wasps, hornets, and ants. The Vespidae family (wasps, yellow jackets, hornets) tend to be more aggressive, while the Apidae family (honeybees, bumblebees) are generally less aggressive unless provoked.
Typical Presentation
Patients may present after one or multiple stings, often occurring outdoors. Severe reactions are more likely in cases of multiple stings or in individuals with allergic sensitivity.
Clinical Features
Local reactions include pain, redness, swelling, and warmth at the sting site. Systemic reactions may involve widespread hives (urticaria), wheezing, shortness of breath, chest discomfort, nausea, vomiting, airway swelling (stridor), altered mental status, and in severe cases, shock or coagulopathy. Anaphylaxis can occur even after a single sting in sensitized individuals.
Mechanism of Action
Venom from these insects contains substances such as melittin, histamine, phospholipases, and other mediators that trigger inflammation and mast cell activation. This can lead to allergic reactions ranging from mild to life-threatening.
Management
Treatment is supportive. Any retained stingers should be promptly removed by scraping to prevent further venom release. Anaphylaxis requires immediate administration of epinephrine. Additional therapies may include antihistamines, corticosteroids, intravenous fluids, and inhaled beta-agonists for respiratory symptoms.
Key Points
- These stings are a leading cause of fatal envenomation, primarily due to anaphylaxis.
- Severe reactions can occur even with a single sting in allergic individuals.
- Honeybees typically leave behind a barbed stinger, whereas wasps and hornets can sting multiple times.
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