• Small local reactions to insect bites or stings present with localized pain, swelling, and erythema at the site of the bite or sting. Most can be managed symptomatically.

• If a person has been stung and the stinger is still in place:
• Remove it as soon as possible by flicking or scraping with a fingernail, piece of card, or knife blade.
• Never squeeze the stinger or use tweezers, as this will cause more venom to go into the skin.
• Remove ticks as soon as possible.
• Wash the area of the bite or sting with soap and water.
• Apply ice to reduce swelling, if present.
• Do not scratch, as this will cause the site to swell and itch more, and increase the chance of infection.
• If there are signs of a severe allergic reaction (generalized symptoms, breathing difficulties, and/or hypotension) seek urgent medical help.
• Bites from fleas, mites, and bedbugs may be due to an infestation. The source of the infestation should be confirmed and then eliminated.

In depth

• Treat local pain and oedema with cold compresses and oral analgesics (e.g. paracetamol or ibuprofen).
• Treat local itching with topical crotamiton. Alternatively, consider using a mild potency topical corticosteroid (e.g. hydrocortisone 1%).
• Consider an oral sedating antihistamine at night if the itch is interfering with sleep.

In depth

• Follow-up or referral is usually not necessary for anyone with a small local reaction to an insect bite or sting.
• Admission may be required for observation when mild symptoms progress to a severe reaction (uncommon).
• The decision to admit will depend upon the type of reaction, social circumstances, and access to local medical facilities. Exercise clinical judgement in these circumstances.