Insect Stings
and
Insect Bites
The typical bee-sting occurs when a biker runs into a bee at high speed. The poor critter gets tangled up between the chin strap and face, or in the collar of the biker's shirt. Then it stings.
Bees and wasps inject venom with their stingers. (Only honey bees leave a stinger behind. The poison sacs are still attached to the stinger, and continue to pump venom into the skin after the bee departs.) There will be stinging, swelling, and redness at the sting site. Usually, the symptoms subside after 20 to 30 minutes.
Allergy to insect stings can be deadly. Symptoms of allergy can include faintness, dizziness, general itching, shortness of breath, or swelling in places away from the sting site.
A second type of allergy is much less serious. This is delayed swelling around the sting area. It usually starts the next day, and can persist for up to 5 days. The area is red, raised, hot, itchy but not particularly tender.
Infection is also possible. Infection is common with honey bee stings (because of the stinger "foreign body"), but is rare with wasps. Bee-sting infection usually appears as red streaks. Infection is usually tender and non-itchy.
If a stinger is present (honey bee sting), remove it. Drag a sharp object gently across the skin, so it catches the stinger and drags it out. (Objects you might have with you include the knife blade on your Alien tool, the edge of a metal tube scuff pad, or a chip of plastic from your broken bike helmet. Bikers generally don't have long fingernails, but sharp fingernail can also be used to pull the stinger.)
If you're using a knife, don't press hard -- this turns the blade into a "shaver" so it cuts the stinger off at the skin line, leaving part of it in the skin. If you have splinter forceps, steady hands, and good eyes, you can grab the SHAFT (not the top) of the stinger and pluck it out.
Insect Sting Relief pads contain alcohol and benzocaine. Benzocaine is a topical
anesthetic. The pads can relieve the pain of a fresh insect sting. Cold packs can limit
swelling. Elevate the sting area. Take an antihistamine such as diphenhydramine to reduce
swelling and reaction at the sting site.
See the doctor if you:
become short of breath or wheezy
develop a severe throbbing headache
get hives, general redness, or widespread itching
become faint or lightheaded
Ongoing care:
Continue antihistamines until all swelling is gone.
Local swelling:
The day after a bee-sting, you may see severe local swelling. If it's itchy, hardens
gradually to a central "pimple" at the site of the sting, is surrounded by a
thin border of whitened skin, is not particularly tender, tends to go DOWN the extremity
as much as (or more than) it goes up, and is NOT accompanied by fever or body aches, it's
probably a local allergic reaction. This reaction tends to last about 5 days.
Watch for:
Honey bee stings are prone to infection. Wasp stings are more likely to show allergic
swelling (see above). See the doctor if there is increasing tender red swelling around the
wound, red streaks, drainage, fever, tender bumps in the groin or armpit upsteam from the
sting, or an unexplained increase in pain or tenderness. See
section on infection.
Scenario:
Lucky mountain bikers. While the horse-jockeys and backpackers are being eaten alive by
mosquitoes and biting flies, we fly down the trail at warp speed, too fast for the
critters. But occasionally, we have to stop to fix a flat tire. Then the bugs find us.
 | An ounce of prevention... An insect repellant containing DEET will keep mosquitoes at bay. For determined the horse flies, you may have to spray your clothing, because they can bite through it. For skin, a tiny bottle of 100% DEET (as at right, size two inches) will last all year, and is easy to pack along for multi-day excursions. |
|
Description:
Mosquitoes, black flies, horse flies, and deer flies inject saliva containing an
anticoagulant before they start sucking your blood. You have an allergic reaction to the
saliva. (Although if you get bitten enough, eventually the reaction is less severe -- kind
of like allergy shots.) There are two types of reaction: immediate edema (watery swelling)
caused by antibodies, and delayed cell-mediated hypersensitivity caused by your immune
cells.
Concerns:
Severe (life-threatening) allergy to insect bites is rare. Symptoms of systemic allergy
can include faintness, dizziness, general itching, shortness of breath, or swelling in
places away from the site of the bite.
The second type of allergy is annoying, but not dangerous. This is allergic swelling
around the area of the bite. It usually starts the next day, and can persist for up to 5
days. The area is red, raised, hot, itchy and tender.
Immediate care:
If you come home itching, take an antihistamine such as diphenhydramine (sample brand Benadryl).
An adult can use 50 mg (2 over-the-counter caps) every four hours. If you're prone to prolonged
itching, scrub the bite well with soap and water, let it dry, then rub hydrocortisone 1% cream
into the bite.
Put another dab of hydrocortisone right on top of the bump, then cover it with a bandaid. The bandaid drives the medicine into the skin -- and it keeps your fingernails away.
For the delayed hypersensitivity, antihistamines alone won't cure the underlying problem. Take an anti-inflammatory medicine, such as ibuprofen 600 mg four times daily. Apply warm packs, 20 minutes every two hours. If it's itching, add diphenhydramine 50 mg every four hours. Rub hydrocortisone 1% cream over the bite site three times daily. If the reaction is particularly severe, you may need to see the doctor for steroid pills (such as prednisone or Medrol).
Watch for:
See the doctor if there is increasingly painful red swelling around the wound, red
streaks, drainage, fever, tender bumps in the groin or armpit upsteam from the bite, or an
unexplained increase in pain or tenderness. See section on
infection.
Black Widows are shy spiders, usually hanging out in the dark. So it's unlikely you'll encounter one while riding your bike. It's more likely one will be hiding under your CamelBak in the garage, ready to nip your finger as you pick up the pack.
Description:
You'll always feel a black widow bite. It feels like a sharp pinprick. Looking closely at
the skin, you may see a couple of tiny red fang-marks about 2 mm apart. Within minutes, the
area around the bite becomes vaguely reddened, to a diameter of about an inch or two. The
area begins to tingle. In a half-hour or so, painful muscle cramps develop upstream from
the bite. (If the bite is on the leg, the thigh then the abdomen will begin to cramp and
hurt. If the bite is on the arm, the venom affects the upper arm and shoulder, then the
chest.) As the poisoning progresses, there's shortness of breath, chest pain, and
generalized muscle pains.
Concerns:
While a black widow bite is very painful, it rarely kills a grown adult. But children and
elderly victims can die.
Immediate care:
Get to the hospital. You may require IV medication (calcium, muscle relaxers like
diazepam, and narcotic pain medication). For life-threatening bites, antivenin may be
required.
Scenario:
You won't be bitten by a brown recluse while biking in Utah. The spiders don't live here in Utah's outdoor environment. Bites occur here -- rarely -- in "shipping" settings, where a spider arrives on goods transported from other states.
(A similar spider, the desert recluse, is found in the St George area. It looks
like a brown recluse to non-experts. And there are lots of spider species that
have a sort-of violin marking on their back or stomach. But no, urban legends
aside, brown recluse spiders are NOT found in Utah.)
Description:
The brown recluse (fiddleback spider) has tiny fangs. The bite is almost never felt.
Because this spider is reclusive, it usually isn't seen either. The bite starts as a
blister, which then becomes bloody. The blister pops, leaving an ulcerated hole in the
skin that gradually enlarges over many days.
Immediate care:
Relax. First of all, that funny bump on your skin almost certainly ISN'T a brown recluse
bite. For every real spider bite we see in the ER, 100 patients show us their
"spider bite" and it's really a boil, folliculitis, impetigo, poison
ivy, mosquito bite, cactus thorn, or whatever. Second, we don't do much about
brown recluse bites. We just bandage the sore and watch for
infection. Most other therapies, such as cutting the bite area out, using steroids, etc,
are controversial. If you do develop an enlarging skin sore, go see your doctor.
You just ran into a huge spider web that was strung across the bike trail. As you try to brush a critter off your arm (without crashing the bike), it bites you.
Description:
There are quite a few spiders in Utah that can inflict a nasty bite. Wolf spiders and
garden spiders do the most biting. But the bite isn't dangerous. You may develop some
local swelling and pain at the site of the bite. The local reaction can persist for
several days, and often looks like an infection. (It rarely IS infection, but if you go to
the doctor, he'll probably treat it as infection just to be safe.) The only Utah spider
that's truly dangerous is the black widow.
Utah's tarantulas may look pretty gruesome, but their bark is worse than their bite. (And they don't bark. They almost never bite, either.) Bikers usually don't encounter tarantulas because they only come out at night.
Concerns:
Rarely, there can be an immediate allergic reaction to the bite. Symptoms of allergy can
include faintness, dizziness, general itching, shortness of breath, or swelling in places
away from the sting site.
Infection of the bite can occur, but is rare. See the section on infection.
More likely to occur is a local inflammatory reaction to the venom. It usually starts the
next day, and can persist for up to 5 days. The area is red, raised, hot, itchy and
tender. (In general, if the swelling is itchy and goes as far DOWN the extremity as it
does up, it's allergic inflammation -- not infection.) If this gets you thinking about brown recluse bite, don't. They don't exist in Utah.
Immediate care:
Wash the area thoroughly with soap and water. If it's itchy, cover it with hydrocortisone.
Put a bandaid over the hydrocortisone to keep the medicine in place. Take diphenhydramine
(sample brand Benadryl) for itching.
Ongoing care:
If itchy red swelling develops around the bite (usually the next day), continue to apply
hydrocortisone cream. Add an anti-inflammatory medicine such as ibuprofen, 600 mg four
times a day. Warm compresses may help hurry things along. Expect 4-5 days for the swelling
to resolve.
Watch for:
If you have painful spreading redness, see the doctor. Many patients come to the
ER saying they have a "spider bite" and what they actually have is an
infection that requires antibiotics. In a true spider bite, local swelling and redness is usually a cell-mediated allergic inflammatory
response. Go to the doctor if you suspect infection.
Scenario:
May and June are wood tick season in Utah. The tick gets onto you when you brush
against vegetation. From there, it will crawl upwards, looking for a protected site to
attach. The places the tick likes are groin, armpit, and back of the scalp just above the
neck.
The tick clamps down with pinchers, then begins sucking blood. As the tick engorges, its body changes from flat blackish-brown to round and gray.
Concerns:
Removing the tick can be tricky. Usually, you can't get it out with just
your fingers. The little critter is tiny, wiggly, and slippery. And if you bring your
fingernail and thumbnail together to get a better hold, you'll likely pinch
off the head, leaving
it attached to your skin. Other methods you've heard about -- touching the
tick with a match, smearing the tick with lotion -- almost never work.
A tick might infect you with various spooky diseases, like Ehrlichiosis, Babesiosis, Rocky
Mountain Spotted Fever, Colorado Tick Fever, and Lyme Disease. But in Utah these diseases are
rare. Even the ticks are healthier here.
Grasp the tick with tweezers or needle-nose pliers. Get as close to the tick's head as you can, so you've got a good grip on the tick's upper body where the legs come out. (If the tick's abdomen is fat with blood, grab the tick from the side with tweezers at a 45-degree angle, so you're only holding the chest.) Pull back steadily until the tick pops free. Once the tick is out, wash the area with soap and water.
If the tick is too tiny to get hold of -- for example a little east-coast deer tick -- you can scrape the critter off with a knife blade using a shaving motion.
Ongoing care:
Check the bite site periodically for redness, swelling, or drainage. If you left the head
or pinchers behind in the skin, you get infected. See our page about signs of
infection.
Watch for:
During the three weeks after the tick bite, see the doctor if you develop:
- fever
- rash
- unexplained body aches
- prolonged headache
