Guide · First aid

Stings and severe allergic reactions

Most insect stings cause only local pain and swelling. But a severe allergic reaction (anaphylaxis) can kill within minutes. If someone has trouble breathing, a swelling tongue or throat, or feels faint after a sting, food or medicine, call your local emergency number (112 in Europe and many other countries, 911 in North America) straight away and use their adrenaline auto-injector if they have one.

Ordinary stings

1. Move away from the area, as more insects may come.
2. If a bee sting is left in the skin, scrape it out sideways with a fingernail or card as quickly as possible. Speed matters more than method.
3. Wash the area with soap and water.
4. Hold a cold pack or cold, wet cloth on it for 10–20 minutes.
5. Raise the area if you can. An antihistamine tablet and a simple painkiller can ease itching and pain.

Get medical help for stings in the mouth or throat (give ice to suck while you wait), for many stings at once, or if redness and swelling keep spreading over the next few days.

Signs of anaphylaxis

Usually within minutes, but sometimes up to an hour or two later:

• Airway: swollen lips, tongue or throat, hoarse voice, difficulty swallowing
• Breathing: wheeze, noisy breathing, shortness of breath, persistent cough
• Circulation: pale or clammy skin, dizziness, fainting, confusion, collapse

There may also be an itchy rash, hives, flushing, stomach pain or vomiting, but a rash isn't always present.

What to do

1. Use the auto-injector. Help them use their own, or give it yourself if they can't. Remove the safety cap, press it firmly against the outer side of the thigh — through clothing is fine — and hold it there for as long as the instructions say, usually a few seconds.
2. Call emergency services and say "anaphylaxis", even if they start to feel better.
3. Lie them down with their legs raised. If breathing is hard, let them sit up, but don't let them stand or walk, even if they feel better — this can cause sudden collapse.
4. Second dose: if there is no improvement after 5 minutes, or symptoms come back, give another auto-injector if one is available, into the other thigh.
5. Stay with them and watch their breathing. If they become unresponsive and stop breathing normally, start CPR.

Afterwards

Everyone who has had anaphylaxis must go to hospital, even if they recover quickly. Symptoms can return hours later. Antihistamine tablets do not treat anaphylaxis — adrenaline does.

If you have a known allergy

Carry two auto-injectors at all times, check their expiry dates, and show the people you travel with how to use them.

This guide does not replace a first-aid course. A few hours of hands-on practice will make you far more confident when it matters.

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