Insect bites and stings
Almost everything that bites or stings over the summer leaves an itchy lump that fades in a few days and needs nothing but patience.
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Medicines commonly prescribed for Insect bites and stings
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: TABLET, 10 mg cetirizine dihydrochlorideActive substance: cetirizineManufacturer: Ucb Pharma S.A.Prescription requiredDosage form: INJECTABLE, 6.7 mgActive substance: somatropinManufacturer: Sandoz GmbhPrescription requiredDosage form: TABLET, 10 mg cetirizine dihydrochlorideActive substance: cetirizineManufacturer: Retrain, S.A.U.Prescription required
Almost everything that bites or stings over the summer leaves an itchy lump that fades in a few days and needs nothing but patience. Three things are worth knowing about, because they turn an ordinary bite into something else: a severe allergic reaction, which builds within minutes; infection, which starts later and keeps getting worse; and the illnesses carried by ticks and mosquitoes. What follows is how to tell them apart and what to do in each case.
What an ordinary bite looks like, and when it stops being one
Bees, wasps and hornets sting at once and it hurts; mosquitoes and midges go unnoticed and itch afterwards. The usual reaction is a lump up to a couple of centimetres across, red or simply firm to the touch, with a pink patch around it, itching and burning. On brown and black skin the redness may not show at all, but the swelling can be felt easily. All of this builds over a few hours and settles within two or three days.
There is also the large local reaction: the swelling spreads ten centimetres or more, a whole hand puffs up after a sting on one finger, and the skin feels tight and hot. It looks alarming but carries no danger, and it means only that the body has responded vigorously. Its signature is the timing: the swelling grows over the first day or two and then starts going down.
Infection follows a different timetable. On the first day there is none; it starts on the second or third and only worsens from there. Take notice if the pain eased and then came back, if the redness is spreading beyond the original patch, if the skin is hot, if pus is coming out, if a temperature has appeared, if the glands have swollen, or if a red line runs from the bite towards the body. That needs a doctor the same day: it is treated with antibiotics, not with creams.
Three more situations call for a doctor without hesitation: a bite or sting in a baby under one year old; a sting inside the mouth, on the tongue or in the throat, for instance when a wasp has got into a drinks can, because swelling there closes off the airway even with no allergy involved; and multiple stings running into dozens, since the sheer quantity of venom brings on vomiting, fever and weakness.
What has to come out of the skin
If something is still in the skin, get it out first and deal with the itch afterwards.
- A bee sting. Scrape it out sideways with a fingernail, the edge of a bank card or the blunt side of a knife. Better not to grab it with tweezers: squeezing the sac pushes the rest of the venom into the skin. Speed matters more than technique here. Wasps and hornets leave no sting behind.
- A tick. Use fine-tipped tweezers or a purpose-made hook, grip the tick right against the skin and pull straight upwards without twisting or jerking. Do not smother it in anything, not oil, not alcohol, not glue, and do not burn it: that makes the tick push its gut contents back into the wound. If the head stays behind it will work its way out like a splinter, so leave it alone. Wash the site, clean it with antiseptic and note the date, which you will want if something appears weeks later.
- Caterpillar hairs. Processionary caterpillars, which travel nose to tail along pine trees, shed extremely fine irritant hairs, and standing under the tree is enough. Do not rub the skin, as that drives the hairs deeper. Lift them off with sticky tape, rinse under running water, take the clothes off and wash them hot, and keep your hands away from your eyes. If hairs get into the eyes, or breathing becomes difficult, see a doctor straight away.
How to settle the itch and swelling
Wash the area with soap and water. After that only a few things help, but they do help.
- Apply something cold wrapped in cloth for fifteen to twenty minutes, repeating as needed. Ice does not go straight onto the skin.
- Keep the bitten arm or leg raised: the swelling goes down noticeably faster.
- Take off rings, bracelets and watches early, before the hand swells.
- Antihistamines by mouth work for the itch. Hydrocortisone cream in a short course settles itching and swelling, but it does not go on broken skin or on the eyelids without advice.
- If it is painful, ordinary over-the-counter painkillers will do; ask a doctor or pharmacist which to choose, particularly if you take anything else.
- Do not scratch. Almost every infected bite began as a scratched one. Cut children's nails short and cover the spot at night.
- Bicarbonate of soda, vinegar, toothpaste and the rest of the household remedies do nothing for the itch and make irritated skin worse.
Severe allergy: what to do at once
A dangerous reaction develops within minutes and almost always involves more than the site of the bite. Call an ambulance, in Europe on the single number 112, if any of the following appears:
- swelling of the lips, tongue, throat or face;
- fast or laboured breathing, wheezing, or a feeling of not getting enough air;
- a throat that seems to be closing, difficulty swallowing, or a hoarse voice;
- skin, lips or tongue turning blue, grey or pale, which shows up more readily on the palms and soles if the skin is dark;
- sudden confusion, marked weakness, dizziness or loss of consciousness;
- in a child, floppiness, a limp body and no normal response to you;
- an itchy raised rash breaking out all over the body, often with abdominal pain and vomiting.
While the ambulance is on its way, the order goes like this. If the person has an adrenaline auto-injector prescribed, use it first, into the outer thigh and through clothing if necessary; there is no waiting to see whether things get worse, because delay is more dangerous than an unnecessary injection. Then lay them on their back with the legs raised; if breathing is hard let them sit up, and if they are unconscious or being sick, turn them on their side. Do not stand them up suddenly or walk them anywhere: that is the moment at which the heart most often stops. If there is no improvement after five to ten minutes, a second dose goes into the other thigh.
Even if it settles by itself, go to hospital: the reaction can return several hours later. And after anything of the kind, ask to be referred to an allergy clinic. For bee and wasp venom there is a treatment that trains the body over several years to stop reacting so violently, and in this allergy it is among the most reliable treatments there is. Carry the auto-injector with you and keep an eye on its expiry date.
What ticks and mosquitoes carry
In our latitudes ticks are the greater danger, and not because of the bite itself.
Lyme disease shows up days or weeks later: a red patch appears where the tick was, spreading slowly into a ring that often clears in the middle. It usually neither hurts nor itches, so it is easy to miss, and on dark skin the ring may look simply like a slightly darker area. Aching, fever and tiredness sometimes come with it. This is a reason to see a doctor: the illness responds well to antibiotics early on and much less well once it has reached the joints and nerves. The risk of infection is lower the sooner the tick comes off, so it is worth checking yourself the same evening you get back.
Tick-borne encephalitis occurs in wooded parts of central and eastern Europe. It begins like a cold one or two weeks after a bite and can then bring a severe headache and a stiff neck. There is no treatment for it, but there is a vaccine: if you live in such an area or plan to spend time outdoors there, ask about it in advance.
Mosquitoes occasionally carry viral fevers in Europe, and malaria and dengue in the tropics. The rule is simple: any fever in the months following a trip to the tropics means seeing a doctor the same day and saying where you have been. Malaria moves fast and in the first days looks like ordinary flu.
How to collect fewer bites
- Put a repellent containing diethyltoluamide or icaridin on exposed skin and reapply it as the label says; for children, use a product approved for their age.
- In woodland and long grass wear light-coloured long sleeves and tuck trousers into socks, so that a tick shows up against the fabric and has a harder time reaching skin.
- When you get back, check yourself and the children all over, particularly behind the knees, in the groin, behind the ears, on the scalp and along the waistband. Shake the clothes out and wash them.
- Against mosquitoes, screens on the windows and a net over the bed work, and in the garden so does tipping the water out of butts, buckets and plant saucers, which is where they breed.
- Do not swat at wasps, since sudden movements provoke them. Keep sweet drinks covered outdoors and do not drink from a can without looking inside.
Online consultation
The main question is one that answers well remotely: is this still normal swelling or is it now infected, and are antibiotics needed. From a photograph and from the timing, meaning what appeared on which day, a doctor can separate a large local reaction from an infection, look at the patch left after a tick and say whether it resembles Lyme disease, and advise on settling a child's itch or on what is safe in pregnancy. It is also a good moment to work out whether you need the tick-borne encephalitis vaccine and how to prepare for a trip to the tropics. Signs of severe allergy are not handled remotely: for those, call an ambulance immediately.
This material is for information only and does not replace medical advice.
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