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The buzz on insect bites
Wasps, hornets, bees, mosquitoes, spiders, fleas, chiggers, ticks, and ants all bite or sting. And for little mouths (or stingers), they can cause some real discomfort. Despite the discomfort, insect stings are for most of us merely temporary irritations that can be relieved with first-aid remedies. Apply ice to the sting or use nonprescription products to help relieve itching, swelling, redness, and burning. However, if you're allergic to insect bites, any sting should be considered dangerous and potentially life-threatening. Seek prompt medical attention for systemic reactions to stings; an immediate injection of epinephrine might be necessary to combat the effects of the venom.
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Helping to Take Some of the Sting out of Stings
Unless you're hypersensitive to the bites or stings of insects, first-aid procedures and products can help relieve the discomfort. Carrying some basic first-aid supplies is advisable if you're going to be participating in an activity where stinging insects are prevalent -- camping, fishing, hiking, and even barbecuing. Steps to take when an insect bite occurs include the following:
- In the case of a bee sting, remove the stinger carefully to avoid squeezing more venom from the stinger into your body. For this reason, use tweezers instead of your fingers. If the stinger is removed within two to three minutes of the sting, some of the venom may be prevented from entering your system.
- Wash the bite area with soap and water.
- If available, apply a topical antiseptic to fight bacteria.
- Apply an ice pack to the sting or bite to reduce itching, swelling, and pain.
- Take an oral antihistamine to help reduce the swelling.
- Use one of the various over-the-counter creams, lotions, or ointments approved for the relief of inflammation. Try hydrocortisone first.
- For ant bites, if over-the-counter products aren't available, a paste of baking soda and water may provide some relief.
- External analgesics/antipruritics -- including counterirritants, local anesthetics, antihistamines, and hydrocortisone -- are safe and effective in sting relief, but should not be used on children under age 2 without the advice of a physician.
When Stings Are Serious
- If a bite leaves you feeling faint, nauseous, or sweaty, go to the nearest hospital emergency room. You might be experiencing the early signs of anaphylactic shock.
- If you suspect you're allergic to insect bites, carry a special first-aid kit with prescription drugs. Consult with your physician.
- If you know you're allergic to insect stings, carry a card or tag to alert others to your sensitivity in case of an emergency. Wear protective clothing and use repellents when stinging insects are prevalent.
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Counterirritants
Commonly used in ointments because they reduce pain sensations by stimulating alternate nerve sensations. In other words, they take your mind off the pain by causing a distracting cooling or heating sensation. Unfortunately, they also stimulate blood flow to the area, which can cause swelling, and they may irritate the already sensitive skin.
Topical anesthetics
Extremely common components of anti-itch preparations. Pain and itch sensations are carried over the same nerves. Anesthetics work by suppressing sensory nerve transmission to lessen the perception of pain and itch. The higher concentrations are appropriate for use on intact skin, but lower concentrations are recommended for broken skin. Should not be used for serious burns, burns that cover large portions of the body, or more than four times daily. Be aware that some people are allergic to these products. Use over broken skin may lead to toxic effects.
Antihistamines
Reduce symptoms of itching by preventing the histamine from binding to its receptor and through an anesthetic action. The topical form should not be used for longer than seven days. Only three antihistamines are approved by the FDA for topical use.
Hydrocortisone
A topical corticosteroid useful for reducing inflammation and itch. Works by reducing your body's inflammatory response. Should not be used on broken skin or for extended periods of time since it can thin the skin and slow wound healing. Prolonged use can also lead to tolerance and reduced effectiveness.
Skin protectants
Prevent skin irritation by forming a physical barrier between the skin and the irritating agent. They also soothe and soften the skin, keeping it moisturized and reducing friction. In this way, they may offer some relief from itching and pain.
| Counterirritants | Ingredient | Description |
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| Camphor | ? | At concentrations of 0.1% to 3.0%, camphor is used as a topical pain reliever and anesthetic. In concentrations over 3%, camphor induces relief of pain and discomfort by stimulating nerve endings. High doses are not recommended, as camphor is toxic. | | Ichthammol | ? | Can inhibit the growth of bacteria and has counterirritant characteristics, reduces redness (inflammation) and constricts small blood vessels. It can cause unsightly thickening of the skin where it is applied. | | Menthol | ? | Usually combined with other ingredients with antipruritic or analgesic properties, such as camphor. At low concentrations (0.1% to 1.0%) menthol is used as an antipruritic, but there are no controlled studies to attest to its efficacy. In higher concentrations it is used as a counterirritant. Menthol causes sensitization in certain individuals, although the sensitization index is low. Symptoms include urticaria, erythemia, and other cutaneous lesions, such as contact dermititis. | | Methyl Salicylate | ? | Safe and effective as a counterirritant when used properly, but highly toxic if ingested. It is one of the most widely used counterirritants. | | Topical Anesthetics | Ingredient | Description |
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| Benzocaine | ? | Benzocaine is effective and very safe in adequate concentrations, and provides long-lasting relief (a single application may provide itch-pain relief for four to six hours). However, a small percentage of users experience some irritation or sensitivity. | | Cylcomethycaine | ? | A safe product that has not been deemed effective. | | Dibucaine | ? | An effective anesthetic that should not be used over large surfaces to reduce the risk of toxicity. | | Phenol | ? | Phenol has a strong ability to kill or inhibit disease-causing bacteria and other microorganisms, and it is widely used as a disinfectant. It also has anesthetic properties that relieve pain and itching, and is an acne remedy and an antifungal agent acting against athlete's foot. However, it is extremely toxic; concentrations over 2% can cause skin to peel and die and may even cause systemic poisoning when applied externally. It is especially dangerous when used to treat diaper rash. Recent studies suggest phenol may be carcinogenic. | | Ammonium Hydroxide and Triethanolamine | ? | An anesthetic that is claimed to reduce the effectiveness of insect venoms. | | Antihistamines | Ingredient | Description |
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| Diphenhydramine | ? | A popular and effective antihistamine, it has a strong sedating effect. One of the three antihistamines available in topical form for OTC use. | | Pyrilamine | ? | Highly effective. Even at high doses, this drug is not likely to produce fatal toxic effects. Not commonly found in OTC products. | | Tripelennamine | ? | Available as a topical antihistamine in OTC products to help relieve itchiness. | | Hydrocortisone | Ingredient | Description |
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| Hydrocortisone | ? | An effective anti-inflammatory agent, hydrocortisone should be used with caution if the skin is broken because it may allow infections to develop. | | Skin Protectants | Ingredient | Description |
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| Aluminum Acetate | ? | When applied to the skin (as it should be) complications are rare or nonexistent. It is safe and effective in relieving poison ivy and other irritating skin conditions. It can be used as a soak or applied to a larger skin area as a wet dressing. | | Glycerin | ? | In a 20% to 45% concentration (as recommended), glycerin will hold water to the skin so it stays moist and is not irritated by wind, air, and other drying forces. | | Hamamelis Water | ? | Also known as witch hazel, this ingredient possesses astringent properties and may act as a hemostatic for small superficial wounds. | | Titanium Dioxide (Conditionally Approved) | ? | Titanium dioxide has not been thoroughly evaluated by the FDA. | | Zinc Oxide | ? | Zinc oxide is used to cover the skin and protect it from dryness and other harmful environmental stimuli. It also absorbs toxic substances and serves as a lubricant. This substance is extremely safe. |
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FDA-Approved Uses
Antiseptics and antibiotics
- Decreases the risk of infection, bacterial contaminant, and skin infection in minor scrapes, cuts, and burns
Pain and itch relievers
- For the temporary relief of pain and itching associated with minor burns, sunburn, minor cuts, scrapes, insect bites, minor skin irritations, and rashes due to poison ivy, poison oak, or poison sumac.
Skin protectants
- Provides temporary skin protection and relieves minor irritation and itching due to poison ivy, poison oak, poison sumac, and insect bites.
- For the temporary protection of minor cuts, scrapes, burns, and sunburn
Astringents
- For temporary relief of minor skin irritations due to poison ivy, poison oak, poison sumac, insect bites, athlete's foot, or rashes caused by soaps, detergents, cosmetics, or jewelry.
- Stops bleeding caused by minor surface cuts and abrasions, as may occur during shaving.
Safely Removing Stingers- In the case of a bee sting, remove the stinger carefully to avoid squeezing more venom from the stinger into your body. For this reason, it is best to use tweezers and not your fingers. This prevents all the venom from entering your system. Try to remove the stinger before it empties its toxins into your body. This usually takes about two to three minutes for bee stings.
- Wash the bite area with soap and water.
- Applying meat tenderizer to the site may help inactivate some of the venom.
- If available, apply a topical antiseptic to fight bacteria.
- Apply an ice pack to the sting to reduce itching, swelling, and pain.
- Take an oral antihistamine to help reduce the swelling.
- Use one of the various nonprescription creams, lotions, or ointments approved for the relief of inflammation.
Applying Topical Creams- Clean and dry the affected area before applying any medication.
- Up to four applications of medicated oitments may be used per day.
- If symptoms do not improve within seven days or if they worsen, consult a doctor.
- Consult a doctor if you suspect infection or if the wound occurred in a dirty area. Do not risk infection.
Keep Bacteria Out- Use of a topical antibiotic or antiseptic is recommended as a prophylactic measure.
- Open, swollen wounds are a prime breeding ground for bacteria.
- Topical antimicrobial products help to keep the bacteria in check.
Avoiding Anaphylactic Shock- If you suspect you are allergic to insect bites, carry a special first-aid kit with prescription drugs. Consult with your doctor.
- If you know you're allergic to insect stings, carry a card or tag to alert others to your sensitivity in case of an emergency. Wear protective clothing and use repellents when stinging insects are prevalent.
- These kits contain epinephrine which should be injected after a sting. It helps keep your blood pressure stable.
How to Identify a Serious Food or Insect Bite Allergy- For reasons not completely understood, some people are extremely sensitive to certain foods and/or insect bites. Severe reactions to food or insect venom are the same. When the person is bitten or is exposed to the particular food (either through ingestion or even by just smelling or touching the food), their body launches an aggressive immune response.
- This hypersensitivity can be fatal. Unfortunately, most individuals find out about their allergies by accident. For this reason, it is absolutely vital not to ignore possible signs, the affected person claims to have no known allergies.
- The condition brought on by such allergies is called "anaphylaxis." Its symptoms include the following:
- Difficulty breathing
- Shock
- Hives
- Swelling
- Vomiting
- Nausea
- Cramping
- Abdominal pain
- Swelling in the throat
- Wheezing
- Tightness in the chest
- A tingling or burning sensation
- Each individual's response and time to onset of symptoms will be different.
- The most common cause of death resulting from anaphylaxis is suffocation. Swelling of the throat obstructs the airways and impairs the lungs' ability to draw in and utilize oxygen.
- Death can occur within minutes or hours of initial exposure to the allergen.
- If you have any suspicions that you or someone you know is having an anaphylactic response, get that person to an emergency room IMMEDIATELY.
- The most effective and life-saving forms of treatment need to be administered by health professionals. However, there are some things you can do if help is not available immediately.
How to Treat a Serious Reaction to an Insect Bite or Food Allergy (Anaphylaxis)- People who know they are susceptible to anaphylaxis often receive prescriptions for and carry epinephrine with them for emergencies. This epinephrine is in readily injectible containers.
- With one hand, pinch a fold of skin at the injection site.
- You want to pull the skin away from the muscle to avoid injecting the epinephrine into the muscle. Inject the epinephrine subcutaneously (under the skin).
- Hold the needle at a 90-degree angle (perpendicular to the injection site) and insert the needle.
- Before injecting the contents of the plunger, pull the plunger back slightly to make sure you haven't hit a blood vessel.
- If not, proceed by depressing the plunger to complete the injection.
- When finished, remove the needle quickly.
- Recap the needle carefully to avoid accidental sticking.
- If the reaction is mild, this should be sufficient. If the reaction is severe, repeat the injection every 20 minutes.
- If there has been a sting, reduce the spreading of the allergic material by immediately tying a tourniquet near the site.
- Inject the epinephrine near the site.
- Remove the stinger without applying pressure to the site because pressure can encourage uptake of the allergen.
- Remember, the afflicted person must get medical attention IMMEDIATELY even after successful injection of epinephrine. The danger is not completely over so, even if the person feels fine, see a doctor immediately.
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Warnings
Antihistamines (topical)
Consult a physician before using or do not use if you have:- A pre-existing skin infection
- Allergy to any antihistamines
- Skin conditions such as psoriasis or eczema
- Open sores or wounds
Or if you:- Plan on using over large wounds or blistered areas
Antihistamines (oral)
Consult a physician before using or do not use if you have:- Allergy to any antihistamines
- Chronic respiratory conditions
- Enlarged prostate
- Glaucoma
- Urinary obstruction
Or if you:- Are pregnant or a nursing mother
- Are a senior, you may require a lower dosage with urinary difficulties
- Are administering to a child under age 6
- Drive or operate machinery requiring alertness, dexterity, or quick reflexes
Or if you are taking:- Alcohol: increases antihistamine side effects
- CNS depressants, such as:
- Diazepam (Valium): increases antihistamine side effects
- Phenobarbital (Luminal): increases antihistamine side effects
- Monoamine oxidase inhibitors (a class of antidepressants), such as:
- Phenelzine (Nardil): increases antihistamine side effects
- Tranylcypromine (Parnate): increases antihistamine side effects
- Other antihistamines: increases antihistamine effects
Counterirritants
Consult a physician before using or do not use if you have:- Allergy to any counterirritants
- Open wounds or sores
Or if you:- Plan to apply to wounds, lesions, broken, damaged, or sensitive skin
- Plan to apply near eyes or other mucous membranes
- Plan to apply over large wounds or blistered areas
Hydrocortisone
Consult a physician before using or do not use if you have:- Allergy to hydrocortisone products
- Open wounds or sores
- Skin infection
Or if you:- Develop rash or other skin irritation after use
- Plan to apply near eyes and mucous membranes
- Plan to apply to wounds, lesions, broken, damaged, or sensitive skin
- Plan to use for more than three days
Topical anesthetics
Consult a physician before using or do not use if you have:- Allergy to any topical anesthetics or any component in burn and sunburn products
- A pre-existing skin infection
- Open wounds or sores
Or if you:- Have symptoms that do not improve within seven days or worsen, consult a doctor
- Plan to use more than three or four times daily
- Plan on using over raw surfaces or blistered areas
- Plan to use on serious or large burns
- Plan to apply to large areas of the body or under compresses or bandages
Skin protectants
Consult a physician before using or do not use if you have:- Allergy to any skin protectants or other component in burn and sunburn products
Common Side Effects
Antihistamines (topical)
Counterirritants
Hydrocortisone
Topical anesthetics
Infrequent to Rare Side Effects
Antihistamines (topical)
- Allergic skin rash
- Mild skin irritation
Counterirritants
- Allergic skin rash
- Skin irritation
Hydrocortisone
- Allergic skin rash
- Skin irritation
Topical anesthetics
- Allergic skin rash
- Skin burning, itching, or stinging
Effects of Overdose
Antihistamines (topical)
Counterirritants
Hydrocortisone
Topical anesthetics
What to Do in Case of Overdose
Antihistamines (topical)
- For external use only. If swallowed, immediately seek medical attention.
Counterirritants
- For external use only. If swallowed, immediately seek medical attention.
Hydrocortisone
- For external use only. If swallowed, immediately seek medical attention.
Topical anesthetics
- For external use only. If swallowed, immediately seek medical attention.
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Sources & Further Reading
Government Sources
- 1. Food & Drug Administration. Federal Register 10/3/89.
Books
- 1. Covington, TR et al. Handbook of Nonprescription Drugs, Eleventh Ed. American Pharmaceutical Assoc. Washington, DC 1996.
- 2. Kastrup EK et al. Drug Facts and Comparisons. Facts and Comparisons.
- 3. Inlander, CB and Slamans, S. The Over-the-Counter Doctor. Cader Books. New York, NY 1997.
- 4. Zimmerman, Dr. Zimmerman's Complete Guide to Nonprescription Drugs, Second Ed. Gale Research, Inc. 1983.
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