SSM Cardinal Glennon Children's Medical Center
(314) 577-5600
www.cardinalglennon.com
 

Bug Bites and Stings

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. So you should know when a simple ice pack can bring some relief and when a visit to the local hospital is in order.

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 sting area) or a systemic allergic reaction, meaning that the venom causes a reaction throughout the body.

In the case of a systemic reaction, the person may break out in hives. Other symptoms can include wheezing; shortness of breath; rapid heartbeat; faintness; and swelling of the face, lips, throat, or tongue.

If a person has these symptoms, call 911 immediately. If an epinephrine auto-injector (EpiPen) is available, it should be used right away. It hardly ever happens, but severe allergic reactions to bee and wasp 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. Flea bites can cause itching or a rash.

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 Lyme disease. But there have been cases in most states in the U.S., and the disease is also seen in Europe and Asia.

Different types of ticks found throughout the United States can carry other diseases, too, such as tularemia or Rocky Mountain spotted fever. Ticks are often found in wooded or grassy 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.

mosquito bite illustration

But sometimes, infected mosquitoes can give people diseases. You may have heard about West Nile virus, which is transmitted to humans by mosquitoes. The good news is that most people, especially healthy people under 50, who get West Nile virus do not have any symptoms from it. 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.

Mosquitoes in other parts of the world can carry other diseases, such as malaria and dengue fever.

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 think 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 its back. These spiders are small but tough, with a ½-inch body (about 1 centimeter) and 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, under porches, and in woodpiles. 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 many people. Others may notice swelling and skin changes 4 to 8 hours after the bite. The swelling may form a blister, which can later turn black and leave a scar as it heals over the next few months. Chills, fever, rash, pain, nausea and, rarely, more serious symptoms (like seizures or coma) also can follow a bite.

If you think you might have been bitten by a brown recluse spider, wash the area with soap and water, put an ice pack on it, and go to the emergency room right away, even if the bite doesn't look bad.

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-red 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 there are warning signs that give time to act before things get too serious: People who are bitten by a black widow may get pain at the site of the bite, then dull muscle pains, especially in the chest or belly, within minutes to an hour of being bitten. They may develop painful muscle cramps and severe pain, might throw up (or feel like they might), and have chills, fever, or a headache within a few hours.

As the spider's venom spreads in the body, a person may get severe abdominal cramping. If any of these things happen, or if you think you may have gotten a bite from a black widow spider, wash the area with soap and water, put an ice pack on it, and go to the emergency room right away, even if the bite doesn't look bad.

Spider bites can sound scary, but it's actually extremely rare that someone will die from one. Young children and the elderly 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. Or ibuprofen can be used to help reduce swelling while relieving some pain. Some people use a topical 1% hydrocortisone cream (sold in stores without a prescription) to ease itching.

Remove ticks as soon as you notice them. Ticks removed within 24 to 48 hours are less likely to transmit diseases like Lyme disease. Using a pair of tweezers, slowly pull the tick out from its head, which is closest to your skin. Slowly pull upward without twisting. That helps ensure that you remove the whole tick. Have someone help you get ticks in any hard-to-reach places of your body. Clean the area with soap and water, and treat with an antiseptic or antibiotic cream to avoid infection.

Do not try to burn a tick off. Heat only agitates the insect, causing it to burrow deeper into your skin. When you've pulled the tick out, put it in a jar or zip-locked bag. (Your doctor may want you to save the tick so that its type can be identified.)

After a bee or wasp 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 or wasp stings, see your doctor for a prescription for an epinephrine auto-injector. In case of a severe allergic reaction, use the epinephrine auto-injector and call 911. An epinephrine auto-injector is easy to use — your doctor or pharmacist will explain how.

If you're severely allergic to stings, talk to an allergist about getting venom immunotherapy (shots).

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, call 911 right away. If an epinephrine auto-injector is available, it should be used immediately. Symptoms to watch for include:

  • shortness of breath
  • wheezing
  • redness or hives
  • swelling of the face, lips, or tongue
  • feeling like your throat is closing up
  • nausea
  • vomiting
  • weakness

In the case of a black widow or brown recluse spider bite, or if you have any doubt about what kind of spider bit you and you're feeling sick, develop a blister, or 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, try to stay in the center of trails, and avoid woody areas with high grass. Check yourself for ticks every few hours, and as soon as you come inside. 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. Shower as soon as you come in from outdoors. 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 according to the directions 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: Larissa Hirsch, MD
Date reviewed: February 2014