Which physical findings are characteristic of local reactions to Hymenoptera stings?

Answer

Local reactions may include the following:

Erythema, edema, warmth, tenderness
Drainage from site of sting
Compromised distal circulation as result of edema
Distal sensation loss from stings over peripheral nerve
Corneal ulceration from corneal stings
With bee stings, stinging apparatus visible at sting site
If Hymenoptera are swallowed, painful swelling in the mouth or esophagus
Ant stings: Vesicles from fire ants, classic arc of fire ant stings, and ant stings on mucous membranes or conjunctival surfaces cause dramatic swelling in patients who are sensitive. See the image below.
Fire ant bites. In less than 10 seconds, an unwary scientist was stung over 250 times on one leg when he carelessly knelt on a collapsed fire ant mound. The sterile pustules developed to this stage in 3 days. US Department of Agriculture. Courtesy of Wikimedia Commons.
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Urticaria or generalized redness may develop without systemic symptoms.

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Media Gallery

Western paper wasp (Mischocyttarus flavitarsis) building a nest. By Sanjay Acharya (self-made at Sunnyvale, California, USA). Courtesy of Wikimedia Commons.
Yellow jacket. By Richard Bartz, Munich aka Makro Freak (Own work). Courtesy of Wikimedia Commons.
Fire ant bites. In less than 10 seconds, an unwary scientist was stung over 250 times on one leg when he carelessly knelt on a collapsed fire ant mound. The sterile pustules developed to this stage in 3 days. US Department of Agriculture. Courtesy of Wikimedia Commons.
Fire ants. US Department of Agriculture. Courtesy of Wikimedia Commons.

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Author

Randy Park, MD Chair, Associate Professor, Department of Emergency Medicine, Denton Regional Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

James Steven Walker, DO, MS Clinical Professor of Surgery, Department of Surgery, University of Oklahoma College of Medicine

James Steven Walker, DO, MS is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American Osteopathic Association

Disclosure: Nothing to disclose.

Chief Editor

Joe Alcock, MD, MS Associate Professor, Department of Emergency Medicine, University of New Mexico Health Sciences Center

Joe Alcock, MD, MS is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Dan Danzl, MD Chair, Professor, Department of Emergency Medicine, University of Louisville Hospital

Dan Danzl, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Kentucky Medical Association, Society for Academic Emergency Medicine, Wilderness Medical Society

Disclosure: Nothing to disclose.

Hemant H Vankawala, MD Chief Medical Information Officer, Emerus Hospital; Associate Clinical Professor, University of Texas Southwestern Medical Center; Associate Clinical Professor, Texas Tech University Health Science Center; EMS Medical Director, Big Bend National Park and Terlingua Fire and EMS

Hemant H Vankawala, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Society for Academic Emergency Medicine, Texas Medical Association, Emergency Medicine Residents' Association

Disclosure: Nothing to disclose.

Carrie de Moor, MD Adjunct Faculty, John Peter Smith Hospital, Emergency Medicine; Attending Physician, 24 Hour Emergency Room, Centennial Medical Center, Del Sol Emergency Department

Carrie de Moor, MD is a member of the following medical societies: American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Which physical findings are characteristic of local reactions to Hymenoptera stings?

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