There are three major types of reactions that can occur from insect stings.

1. Local reaction:  mild redness, swelling and itching at the sting site, which lasts up to several days.  
2. Large local reactions: these reactions, which develop 10-20% of insect stings, result in a large area of redness and swelling that increase in size over 1-3 days and may last up to a week.   The area can affect an entire limb and is often hot and painful to the touch (often mistaken for a skin infection).   When it affects the arm or leg, it may be so painful as to cause difficulties writing or walking.  
3. Allergic reaction: these reactions, also called anaphylaxis, can be very severe and life threatening.   Symptoms may include body itching, hives, swelling of the tongue or throat, difficulties breathing, abdominal cramping, diarrhea, lightheadedness, loss of consciousness, and even death.    These reactions can occur very quickly after an insect sting - within seconds to minutes of an insect sting.  Other times, it can take a little bit longer to develop, perhaps as lon gas 15-60 minutes.  These reactions can be very severe from the start, or they be mild at first (perhaps just mild hives) then gradually (or suddenly) get severe.  These reactions should not be ignored and emergency care should be seeked immediately.
   

If stung by an insect, try to remain calm and brush the insect away.    Bees often leave their stinger with a venom sack attached into the skin, which will continue to release venom for about a minute.  You should remove the stinger by scraping it off with your fingernails or a credit card.   Avoid using tweezers as squeezing the stinger can release more venom into the body.   Wasps, yellow jackets, and hornets usually do not leave their stingers in the skin.

Local reactions can be treated with a cold moist cloth or an ice pack.  Rubbing the area with a mixture of 3 teaspoons of baking soda and 1 teaspoon of water is sometimes helpful.  Calamine lotion or hydrocortisone cream can also help reduce the swelling and itching.    When large local reactions are severe, doctors sometimes prescribe steroids to help reduce the inflammation.

Fire ant stings often result in a very itchy bump that turns into a blister about 24 hours after a sting.   This blister often contains a whitish substance that looks like pus…but it is not pus.   Although it is very hard to do so, it is best to leave these blisters alone as breaking them open can lead to severe skin infections.  Left alone (and clean), these blisters heal on their own in about a week.

Allergic reactions require immediate treatment.    If you have an epinephrine auto-injector (Adrenaclick, Epipen , Auvi-Q, or Twinject), use it immediately then call 911.    If you do not have an epinephrine auto injector, seek care immediately by dialing 911.

Always carry your epinephrine auto-injector with you.  Because 1 dose may not be enough, it is recommended that you carry 2 doses with you (1 Twinject , 2 Auvi-Q, 2 adrenaclicks, or 2 Epipens) at all times.

Learn how to use your auto-injector before you have a reaction.  The time to learn is not when you are having symptom! 

• Instructions on how to use Epipen
• Instructions on how to use Adrenaclick
• Instructions on how to use Auvi-Q

Have a plan and teach your family, friends, and co-workers how to use the injectors in case you are not able to administer a dose yourself.

Don’t assume your friends, child’s teacher, sitter, or caregiver knows how to use an epinephrine auto-injector—go through all the steps with them.  If you have some expired epinephrine auto-injectors laying around, you can practice using them on an
orange to get a feel of how they really work.

Do not delay in seeking help.   You should always seek emergency treatment (IE. Call 911) when you have an allergic reaction.

Get a medic alert (you can get medic alert bracelets from various places including medic alert or American Medical ID) and don't forget to wear it!  

Definitely!   Allergy shots have been developed to help reduce the risk of allergic reactions in people allergic to honey bees, wasps, yellow jackets, hornets, and fire ants.    With allergy shots (venom immunotherapy), gradually stronger doses of venom extracts are administered over a few weeks or months until a dose equivalent to 2-4 insect stings is achieved.  Once this dose is reached, it is administered about once every 4-8 weeks for several years.  This form of treatment  is very effective and has been shown to help prevent future allergic reactions in 97-98% of treated patients.  They have also been demonstrated to reduce the size of large local reactions.   Venom immunotherapy is not only a life saving treatment, but it also greatly improves quality of life in several ways.    First, people with insect allergies often avoid the outdoors due to fears of getting stung - outdoor activities can again be enjoyed without constantly worrying they will get stung.  Second, individuals with severe large local reactions will see a dramatic reduction in their swelling, pain, and disability.   Everyone, regardless of age, who has suffered an allergic reaction to insects, should be evaluated by a board certified allergist to see if they are a candidate for allergy shots (venom immunotherapy)