Substances
Common Names
Wasps (family Vespidae, including hornets
and paper wasps)
Bees (family Apoidea, including honeybees)
Involved Systems
Immune system (anaphylactic reactions)
Renal system (acute kidney injury from
multiple stings) [1]
Hepatic system (elevated liver enzymes) [1]
Muscular system (rhabdomyolysis) [2]
Hematologic system (coagulopathy,
hemolysis) 22.5% [3]
Presentations
Older adult patients are more frequently
stung on the head and upper limbs [1].
Local reactions such as pain, redness, and swelling are more common and milder in
bee stings.
Systemic reactions—especially with wasp stings—include anaphylaxis, hypotension,
dyspnea, and urticaria. Severe wasp stings can lead to rhabdomyolysis, acute
renal failure, liver injury, and disseminated intravascular coagulation (DIC). [1]
Severity factors
include advanced age, multiple body regions affected, and a high number of
stings (particularly >50). Older patients tend to have slower heart rates
(85.7 vs. 92.4 bpm, p = 0.003) and significantly higher creatine kinase (CK)
levels (1343.3 vs. 239.5 U/L, p = 0.003) [1]
Antidotes / Treatment
Mild to Moderate Cases:
Antihistamines and corticosteroids [1]
Analgesics for pain control [1]
Severe or Anaphylactic Reactions: Intramuscular
epinephrine
Intravenous fluids, oxygen, vasopressors if
needed
Intensive care support for rhabdomyolysis
or renal failure
Hemodialysis in cases of renal impairment
Disposition
About 7.5% of Hymenoptera sting cases result in severe
or fatal envenomation [4].
Bee stings usually lead to mild outcomes—most patients recover without
complications and rarely require hospitalization.
In contrast, wasp stings pose a higher risk for ICU admission and
mortality, especially when sting number exceeds 50.
Key severity predictors include:
- Three
or more stings (OR: 35.87, p = 0.002) or sting sites (OR: 35.2, p
= 0.002) [1]
- Greater
number of stings, wasp species, older age, and stings over multiple body
regions [4].
Wasp stings are more frequently associated with life-threatening outcomes in Taiwan, with incidence peaking from late summer to early autumn.
Although about 25% of systemic allergic reactions are severe, fatal outcomes are rare (0.004) [1].
There is still a need to improve public awareness and the proper use of epinephrine in managing anaphylaxis.
References
1.
Chang CW, Chen HY, Mao CY, Lin
YP, Yang HW, Tan ST, Yu CH, Su YJ. Allergic reactions after Hymenoptera stings
in older adults: A multi-center study. Am J Emerg Med. 2025 Apr 25;94:179-184.
doi: 10.1016/j.ajem.2025.04.044. Epub ahead of print. PMID: 40318385.
2.
Lin CC, Chang MY, Lin JL.
Hornet sting induced systemic allergic reaction and large local reaction with
bulle formation and rhabdomyolysis. J Toxicol Clin Toxicol. 2003;41(7):1009-11.
doi: 10.1081/clt-120026527. PMID: 14705851.
3.
Xie C, Xu S, Ding F, Xie M, Lv
J, Yao J, Pan D, Sun Q, Liu C, Chen T, Li S, Wang W. Clinical features of
severe wasp sting patients with dominantly toxic reaction: analysis of 1091
cases. PLoS One. 2013 Dec 31;8(12):e83164. doi: 10.1371/journal.pone.0083164.
PMID: 24391743; PMCID: PMC3877022.
4.
Nguyen TN, Jeng MJ, Chen NY,
Yang CC. Outcomes of wasp and bee stings in Taiwan. Clin Toxicol (Phila). 2023
Mar;61(3):181-185. doi: 10.1080/15563650.2023.2173075. Epub 2023 Mar 9. PMID:
36892552.
Edited by Yu-Jang Su May, 6, 2025.
