It’s the first day of spring, ushering in the promise of renewal along with a period of increased insect activity as soil warms and thaws, larvae hatch and flowers bloom to attract pollinators.

Insect bites and stings are a relatively common occurrence in many occupations. Reactions to bites and stings are usually mild and can be self-managed with first aid, but in some situations they can be serious or potentially deadly.

This year America’s Poison Centers marks National Poison Prevention Week on March 19-23. The centers, a consortium of 55 organizations, operates a helpline (1-800-222-1222) for people who have questions about exposures including bites and stings, accidental medication overdoses, and drinking, inhaling or touching toxic substances.

 

WorkCare Recommendations

WorkCare’s Nursing Guidelines for 2023 include emergency response and first-aid instructions for bites and stings from bees, wasps, hornets, yellow jackets, spiders, scorpions, fire ants, mosquitoes, lice, ticks, fleas and other insects. According to the guidelines, reactions can range from mild local itchiness or pain to severe life-threatening systemic reactions.

Patients with a known history of systemic reactions who are stung around the mouth or throat, or who have been stung multiple times, have a higher risk for severe reactions and should be carefully evaluated by a medical professional. Systemic reactions occur when inflammation caused by toxins, allergies or infection spread from a localized area, such as the skin, to other organs in the body.

Anaphylaxis is an acute, potentially fatal reaction to an allergen. In addition to bites and stings, triggers for anaphylaxis may include certain foods (such as nuts or shellfish), medications or substances. Anaphylactic shock is a state of extremely low blood pressure (hypotension) and rapid heart rate (tachycardia) that requires an immediate emergency response.

Signs and Symptoms

Signs and symptoms of local bite or sting reactions include:

• Itchiness
• Redness
• Pain
• Swelling
• Burning, numbness or tingling

Systemic bite or sting reactions include

• Hives
• Abdominal pain, nausea, vomiting, diarrhea
• Shortness of breath, wheezing or high-pitched whistling sound
• Generalized swelling, or swelling of the face or throat
• Chest pain, tachycardia, hypotension, low blood pressure
• Dizziness, altered consciousness, fainting

For emergency systemic reactions, after calling 911 or onsite emergency responders, a qualified person may administer CPR, an EpiPen® (or equivalent) and/or Benadryl® (diphenhydramine), as clinically indicated. In non-emergency situations, the following steps are recommended:

1. Assess heart rate and blood
2. Check airway and
3. Inspect bite or sting
4. Check for systemic reactions (e.g., hives, swelling, wheezing).
5. Remove rings or constricting items because swelling may
6. Scape to remove an embedded stinger; do not squeeze the stinger with an
7. Cleanse the bite or sting area with soap and

At WorkCare, we staff onsite clinics and have occupational nurses and physicians available 24/7 to provide telehealth triage. (Refer to our Onsite Services & Clinics and Incident Intervention service lines.) While remaining at work, employees whose employers are clients of our Incident Intervention program and those with WorkCare onsite clinical personnel can get advice on the use of ice and elevation of the affected area and over-the-counter topical antibiotic ointment or hydrocortisone cream, analgesics to reduce pain and inflammation and antihistamines for itchiness.

It is recommended to re-evaluate all insect bites and stings after 24 hours.

Prevention

WorkCare clinicians advise employers to reinforce prevention strategies such as using insect repellant containing DEET; keeping exposed skin covered; not provoking insects whenever possible; avoiding wearing perfumes or brightly colored clothing; and not eating outdoors when insects are active. Individuals with known systemic insect allergies should be encouraged to carry an EpiPen, as prescribed by their primary care provider, and wear a Medic Alert-type bracelet or neck chain.