Insect bites and stings

Also called Wasp sting, Bee sting, Tick bite, Bedbug bites

Almost always trivial. Two things are not: anaphylaxis within minutes, and a spreading bullseye rash weeks after a tick bite.

What it is

Reactions to being bitten or stung by insects and other small creatures. The overwhelming majority are minor and settle within days.

Three situations lift this out of the trivial.

**Anaphylaxis.** A small number of people react severely to bee and wasp venom, with swelling of the face and throat, wheeze, and collapse within minutes. That is a 999 emergency and an adrenaline auto-injector is the treatment. See allergies and anaphylaxis.

**Ticks.** A tick bite can transmit Lyme disease. A spreading circular or bullseye rash days to weeks after a bite in the UK countryside needs antibiotics without waiting for a blood test, because the test is often negative early. Correct tick removal, with fine-tipped tweezers close to the skin, pulling steadily upwards, reduces the risk.

**Infection.** Bites become infected, particularly when scratched, and can lead to cellulitis.

Ordinary large local reactions, a hand or forearm swelling after a sting, look alarming and are not allergy. They settle over days.

Bedbug bites, typically in lines on exposed skin, indicate an infestation that needs professional treatment of the property rather than of the person.

Signs you might notice

A red, swollen, itchy or painful lump appearing within minutes to hours, settling over days.

A large local reaction: swelling extending well beyond the bite, sometimes over a whole limb, but with no other symptoms.

999 immediately, for anaphylaxis: swelling of the lips, tongue or throat; difficulty breathing or wheeze; a hoarse voice or difficulty swallowing; widespread hives; feeling faint or collapsing; a sense of impending doom. Use an adrenaline auto-injector if available and call 999 even if it works.

Same-day: spreading redness, heat and pain over days, with or without fever, suggesting infection; a sting inside the mouth or throat; multiple stings.

See a GP: a spreading circular rash after a possible tick bite, or fever and flu-like symptoms in the weeks after one.

How it can affect day-to-day life

For most bites, the treatment is not scratching, which is easier said than done, particularly for children at night. Antihistamines, cool compresses and keeping nails short all help, and preventing scratching prevents infection.

The distinction between a large local reaction and anaphylaxis matters enormously and is widely misunderstood, causing both unnecessary fear and dangerous complacency.

Anybody who has had a systemic reaction to a sting should be referred to an allergy clinic. Venom immunotherapy is highly effective and is offered far less often than it should be.

Tick exposure in the UK is a countryside and park issue, not an exotic one, and checking the whole body, including the scalp and skin folds, after walks is the practical measure.

Bedbugs are a housing problem, carry heavy stigma, and are not a hygiene failure; they need professional pest control and landlord involvement.

Supporting someone well

For a sting: remove the sting by scraping rather than squeezing, wash, apply a cold compress, and take an antihistamine if itchy.

Do not scratch. Keep nails short, use cool compresses, and consider an antihistamine at night for children.

Call 999 for any breathing difficulty, throat or tongue swelling, or faintness, and use an auto-injector if prescribed.

After any systemic reaction to a sting, ask for allergy clinic referral and ask about venom immunotherapy.

Remove ticks promptly with fine-tipped tweezers, gripping close to the skin and pulling steadily upwards. Do not burn them or use petroleum jelly.

Check the whole body after countryside walks, including children's scalps.

See a GP for a spreading circular rash after a tick bite, without waiting.

For bedbugs, contact professional pest control and the landlord; treating the skin alone achieves nothing.

Where to get help

999 for any sign of anaphylaxis.

A pharmacist for ordinary bites and stings.

A GP practice for infection, a possible Lyme rash, or after any systemic reaction to a sting.

Anaphylaxis UK for allergy information and auto-injector training.