Print Print
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 To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?'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
How do I manage large local reactions to an insect bite or sting?

  • Treat pain with an oral analgesic (e.g. paracetamol or ibuprofen).
  • Treat large local allergic reactions with a short course of an oral antihistamine.
    • Offer a non-sedating antihistamine to control daytime symptoms.
    • Consider giving an additional sedating antihistamine at night if the itch is interfering with sleep.
  • Consider using a short course of oral steroids (e.g. prednisolone for 3–5 days if local swelling is severe).
  • If the airway is affected, treat urgently as anaphylaxis — see the CKS topic on Angio-oedema and anaphylaxis for more information.
Clarification / Additional information
  • For adults use prednisolone 40 mg once a day for 3–5 days depending on the severity of the reaction.
  • For children use prednisolone 1–2 mg/kg once daily for 3–5 days.
Basis for recommendation
  • These recommendations are based on expert opinion from the medical literature [Reisman, 1994; Kemp, 1998; DTB, 2002; Moffitt et al, 2004; Steen et al, 2005].
  • Most people with large local reactions need only symptomatic care. However, if oedema affects the airway, this is a medical emergency and needs immediate treatment and admission to hospital [Ewan, 1998].
  • Oral antihistamines:
    • No published randomized controlled trials have assessed the efficacy of oral antihistamines in the treatment of acute urticaria, although they are widely recognized as the mainstay of treatment.
    • In chronic urticaria, second-generation antihistamines have been shown to be more effective than placebo in controlling itch and the appearance of weals, whilst reducing sleeplessness and lessening interference with daily activities.
  • Oral corticosteroids:
    • No controlled studies have assessed the use of oral corticosteroids in the treatment of large local reactions to insect stings or bites. However, if there is a severe, extensive local reaction, experts recommend a short course of high-dose oral corticosteroids to control symptoms [Reisman, 1994; Moffitt et al, 2004; Steen et al, 2005].
    • In view of the lack of prospective studies of oral corticosteroids for systemic or large local reactions to insect bites or stings, CKS recommends that a 3–5 day course of oral prednisolone is given, in the doses used for an acute exacerbation of asthma [SIGN and BTS, 2005].

© NHS Institute for Innovation and Improvement