Elsevier

The Lancet

Volume 348, Issue 9023, 3 August 1996, Pages 301-302
The Lancet

Articles
Removing bee stings

https://doi.org/10.1016/S0140-6736(96)01367-0Get rights and content

Summary

Background

Conventional advice on immediate treatment of honey-bee stings has emphasised that the sting should be scraped off, never pinched. The morphology of the sting suggested little basis for this advice, which is likely to slow down removal of the sting.

Methods

The response to honey-bee stings was assayed with a measurement of the size of the resulting weal. Injection of known quantities of venom showed that this measurement is a good indicator of envenomisation.

Findings

Weal size, and thus envenomisation, increased as the time from stinging to removal of the sting increased, even within a few seconds. There was no difference in response between stings scraped or pinched off after 2 s.

Interpretation

These data suggest that advice to patients on the immediate treatment of bee stings should emphasise quick removal, without concern for the method of removal.

Introduction

Bee stings are common and painful, and rarely, deadly. 10% of people in a 1981 poll in the UK reported having been stung by bees and wasps in a year, with 0–7% of these having severe symptoms.1 Bee stings cause about 17 deaths per year in the USA.2

Most published advice on the immediate treatment of bee stings states that the sting should be scraped off-perhaps with a knife blade, credit card, or fingernail-and never plucked out by pinching with forceps or fingers.3, 4, 5 Our examination of the structure of the bee sting apparatus caused us to doubt the soundness of this advice, especially since scraping off a sting with a tool takes longer than simply brushing or pinching it off. We tested the relative envenomisation resulting from these two means of removing stings, and the effect of short delays in sting removal.

The sting detaches from the body of a honey bee (Apis mellifera) after stinging humans,6 taking with it the entire distal segment of the bee's abdomen, along with a nerve ganglion, various muscles, a venom sac, and the end of the insect's digestive tract.7 The sting itself consists of two lancets with curved barbs on the outer aspect of their distal end, held in grooves on the stylet. Muscular movements of the detached sting, coordinated by the attached nerve ganglion, move the stylets alternately. The barbs provide one-way traction, so that the sting continues to work itself deeper into the flesh. A valve and piston on the proximal ends of the moving lancets pumps venom from the sac between the stylet and the lancets, and through an opening near the tip into the wound.

Section snippets

Methods

To assay the venom injected by a bee sting, we measured the area of the weal raised on our own forearms after bee stings. In preliminary observations, the raised white weal achieved its maximum size about 10 min after the sting. Measurements were blind: the observer was unaware of the treatment administered. 10 min after each sting was administered, the observer measured the maximum and minimum diameters of the raised portion of the weal, using a digital caliper.

To ensure that weal size was a

Results

Increased venom dose led to larger weal sizes (figure 1). Weal area was approximately a log-linear function of dose (p=0·000016). Injection of water alone raised no weal.

There was a significant increase of weal area with increasing time from stinging to removal (figure 2, p=0·018). Neither location of the sting nor arm had a significant effect (ANOVA p=0·58, p=0·60, respectively).

The weal area in response to stings removed by scraping (mean 80 [SE 5·9] mm2), was greater than that of stings

Discussion

Our sting weal bioassay accurately reflected the quantity of venom received. The increase in weal area with increasing time between sting delivery and removal reflects continuing pumping of venom into the flesh by the detached sting, and it illustrates the importance of even short delays in removing the sting.

The method of removal does not seem to affect the quantity of venom received. This finding contrasts sharply with conventional advice on the immediate treatment of bee stings. Probably

References (8)

  • HRC Riches

    Bee venom hypersensitivity update

    Bee World

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    Allergy to venomous insects

  • J Goddard
  • H Mosbach

    Clinical toxicology of hymenopteran stings

There are more references available in the full text version of this article.

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