CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.
Insect bites and stings - Management
What assessments do I need to make?
- Assess the severity of symptoms.
- Small local reactions present with localized pain, swelling, and erythema at the site of the bite or sting.
- Large local reactions present with severe pain, and oedema that extends beyond the site of the sting or bite.
- Multiple bee or wasp stings may cause systemic toxicity which requires urgent action. It can be fatal, particularly in children.
- Anaphylaxis can occur after an insect sting (usually within minutes), particularly from a bee or wasp, and requires urgent action. Anaphylaxis after an insect bite is rare.
- Late-onset reactions to stings can occur (after several hours), which present as urticarial reactions or serum sickness-like reactions with urticaria, joint swelling, and arthralgia.
- Look for signs of secondary infection.
- This is a common complication of insect bites, and may appear as impetigo, cellulitis, or lymphangitis.
- Signs that suggest a secondary infection include:
- Increasing erythema, oedema, or tenderness beyond the anticipated pattern of response.
- Regional lymphadenopathy — but this can also occur in the absence of infection, as a response to the inflammatory reaction produced by a bite.
- Lymphangitis — a definite sign of infection, usually with Group A beta-haemolytic streptococci.
Basis for recommendation
© NHS Institute for Innovation and Improvement