Bug bites and stings are, for the most part, no more unpleasant than a homework assignment — kind of annoying but basically harmless. Occasionally, though, an insect bite or sting can cause serious problems. You should know when a simple ice pack can bring some relief or when a visit to the local hospital is in order.

Before you find out how to handle your unwelcome guests, come meet the critters who want a little piece of you.

Bee and Wasp Stings

For most people, being stung by a bee is a minor nuisance. The affected area may get a little red or swollen and it may be slightly painful, but that's about it.

Bee and wasp stings can cause real problems for people who are allergic, though. A person can get a localized allergic reaction (swelling, heat, or itching of the skin around the bite area) or a systemic allergic reaction, meaning that the poison causes a reaction throughout a person's body, not just around the bite area.

In the case of a systemic reaction, the person may break out in hives. Other symptoms include wheezing; shortness of breath; rapid heartbeat; faintness; and swelling of the face, lips, or tongue. If a person has these symptoms, it's important to get help immediately. It hardly ever happens, but severe allergic reactions to bee stings can be fatal if the person doesn't get medical help.

Flea and Tick Bites

Fleas can be lumped into the irritating-but-not-serious category as well. They are often found on Fido or Fluffy, but they can also be attracted to you.

Depending on where you live, ticks could ruin a good camping trip. One variety known as deer ticks is known to carry Lyme disease, so the trick is to get them off your body fast. In the United States, the northeastern and upper midwestern states are most affected by the threat of disease from ticks, but some cases have been found in the Pacific Northwest and in northern and southern Europe. Ticks can carry other diseases, too, such as Rocky Mountain spotted fever. Ticks are usually found in heavily wooded areas.

Mosquito Bites

Mosquitoes hang out anywhere people, food, or pools of still water are found. Generally they aren't anything to worry about: They bite, you itch, end of story.

However, there is some concern about West Nile virus, which is transmitted to humans by mosquitoes. The good news is that healthy kids, teens, and adults under 50 are at low risk of catching West Nile virus. And although the virus can put people at risk for developing a serious infection called encephalitis, in reality this hardly ever happens. Less than 1% of the people who are infected with West Nile virus become seriously ill.

Spider Bites

Most spider bites are minor, although they can cause mild swelling or allergic reactions. But a small percentage of teens become ill after being bitten by brown recluse or black widow spiders. Although not everyone will have a reaction, you should see a doctor and get treatment quickly if you know you've been bitten by one of these spiders.

The brown recluse is brown (big surprise) with a small shape of a violin in a darker brown area on the back of its head. These spiders are small but tough: a half-inch body (about 1 centimeter) with legs stretching another inch (3 centimeters) or even more. They are found mostly in midwestern and southern parts of the United States, and they like to hide in dark, quiet places like attics or garages. When humans enter their space unexpectedly, they bite out of fear. The bites usually don't hurt at first — and most people don't even know that they've been bitten.

Brown recluse bites don't cause problems for most people. But in a small percentage of cases, they can lead to skin damage and scarring. The few people who do have a reaction may notice swelling and skin changes 4 to 8 hours after the bite. The swelling may form a blister. If this happens, a dark, scabby material called eschar (pronounced: es-kar) may cover the blister within a week after the bite. Most brown recluse bites get better on their own — but it can take a couple of months. So it's always a good idea to see a doctor for proper treatment.

The black widow is found in southern Canada, throughout the United States, and in Mexico. Easily identified by its shiny coal-black body and orange hourglass shape on its underbelly, it's a similar size to the brown recluse spider and it should be treated as carefully.

Most often, people who have been bitten by a black widow don't even know it until they feel the symptoms. But the good news is that there are lots of warning signs that give you time to act before things get too serious. The venom (poison) in a black widow bite causes a systemic reaction.

Someone who has been bitten by a black widow may get painful cramps within a few hours. These cramps usually make a person feel achy all over, and can spread to include abdominal cramping, which may be severe. The person may also have nausea, vomiting, chills, fever, and headache. If you show any of these symptoms, get to the hospital immediately.

Spider bites can sound scary, but it's actually extremely rare that a person will die from one. Fewer than 1% of the people who report being bitten by a black widow die, and even fewer people die from brown recluse bites. Young children are most at risk.

What to Do

For most varieties of bug bites and stings, antihistamines will help to stop itching and lessen swelling, and acetaminophen can help relieve any pain. Ibuprofen can help reduce swelling while relieving some pain. Some people use a topical 1% hydrocortisone cream (sold in pharmacies without a prescription) to alleviate itching.

Say goodbye to ticks by removing them with a pair of tweezers as soon as you notice them. Ticks removed within 24 to 48 hours are less likely to transmit diseases like Lyme disease. Be sure to pull a tick out from the head, which is closest to your skin, to ensure that you remove the whole thing. Have someone help you get the hard-to-reach places of your body, and pull each one out very slowly. Clean the site with soap and water, and treat with an antiseptic or antibiotic cream to avoid infection.

Do not try to burn a tick off, as the flame only agitates the insect, causing it to burrow deeper into your skin. When you've pulled the tick out, put it in a jar of rubbing alcohol to kill it. (Your doctor may also want you to save the tick so that its type can be identified.)

After a bee sting, if you can see the stinger, remove it as quickly as possible to lessen your exposure to the venom.

Wash the sting or bite with soap and water and keep it clean. Apply some calamine lotion or a paste of water and baking soda (unless the sting is near your eyes). Put an ice pack on the affected area for 15 minutes every few hours or so, or cover the sting with a cold compress. Apply an antibiotic cream to prevent further infection. Using a 1% hydrocortisone cream can reduce redness, swelling, itching, and pain.

If you are allergic to bee stings, see your doctor for a prescription for an epinephrine kit. If used immediately after a bee attack, this shot will stop the allergic reaction before it starts, which could save your life. An epinephrine kit is easy to use — your doctor or pharmacist will explain how.

If you're severely allergic to bug bites and stings, talk to a doctor about getting venom immunotherapy (shots) from an allergist.

Serious Stuff — Seek Medical Help

How do you know when a sting or bite is too much for you to handle alone? If you have any symptoms of a systemic allergic reaction, get to the emergency department right away. These symptoms include:

• shortness of breath
• wheezing
• redness or hives over most of your body
• swelling of the face, lips, or tongue
• feeling like your throat is closing up
• nausea
• vomiting
• chills
• muscle aches or cramps
• weakness
• fever

In the case of a black widow spider bite, or if you have any doubt about what kind of spider bit you and you're feeling sick and have cramps, get to the emergency department immediately. (Take the spider with you if you were able to kill it safely.)

If bites or stings get infected or if an open sore or blister refuses to heal, make an appointment with your family doctor.

Preventing Bites and Stings

Human beings don't have to sit around and wait to be a sample on the insect buffet. Here are some steps we can take to protect ourselves:

• Prevent flea infestations by treating your house (including all carpets, furniture, and pets) regularly during the warmer months. Frequent vacuuming can also help.
• Avoid mosquitoes by staying away from areas where mosquitoes breed, such as still pools or ponds, during hot weather. Remove standing water from birdbaths, buckets, etc.; try to stay inside when mosquitoes are most active (dawn and dusk); and wear insect repellent when you are outside.
• When in tick country, take turns with friends and family checking one another for ticks every few hours. Remove any you find immediately. The most important places to check are behind your ears, on your scalp, on the back of your neck, in your armpits, in your groin area, and behind your knees. If you have a pet with you, check your pet, too! Use tick products on pets to prevent them from being bitten.
• Use insect repellent when spending time outdoors camping, hiking, or on the beach. Repellents that contain 10% to 30% DEET (N,N-diethyl-meta-toluamide) are approved for mosquitoes, ticks, and some other bugs. Repellents that contain picaridin (KBR 3023) or oil of lemon eucalyptus (p-menthane 3,8-diol or PMD) are effective against mosquitoes. Follow the instructions carefully and don't overuse the product — using more than you need won't give you any extra protection. Reapply insect repellent after swimming or if you've been sweating for a long time.
• When you are in wooded areas, tuck your clothes in and try to keep as covered up as possible. Tuck pants into socks, shirts into pants, and sleeves into gloves. Wear shoes and socks when walking on grass, even it's just for a minute. Bees and wasps can sting your unprotected feet.
• Wear gloves if you're gardening.
• Don't disturb bee or wasp nests.
• Don't swat at buzzing insects — they will sting if they feel threatened.
• Be aware that spiders might be hiding in undisturbed piles of wood, seldom-opened boxes, or corners behind furniture, and proceed with caution.

Reviewed by: Elana Pearl Ben-Joseph, MD
Date reviewed: May 2010