Anaphylaxis is a severe allergic reaction of the whole body that starts within minutes of a sting in a person sensitized to bee venom. It can close the airway or drop the blood pressure, so epinephrine must be given right away.
Key symptoms
- Hives, flushing and itching far from the sting site
- Swelling of the lips, tongue or throat; hoarse voice
- Shortness of breath, wheeze, chest tightness
- Dizziness, fainting, a feeling of doom
- Nausea, vomiting, belly cramps
What you find on exam
- Airway: stridor, drooling, swelling of the tongue or lips
- Breathing: wheeze, fast breathing, oxygen saturation
- Circulation: fast pulse, low blood pressure, pale clammy skin
- Find the stinger and scrape it off
Tests
- Anaphylaxis is a clinical diagnosis; never delay epinephrine for tests
- Continuous monitoring: heart rate, blood pressure, oxygen saturation, ECG
- Serum tryptase in the hospital can support the diagnosis later
Treatment basics
- IM epinephrine in the outer thigh at once: 0.01 mg/kg, up to 0.5 mg in adults (0.3 mg auto-injector); repeat every 5 to 15 minutes if needed
- Lay the patient flat with legs raised; let them sit up if breathing is hard
- High-flow oxygen; IV fluid bolus for low blood pressure
- Albuterol for wheeze; antihistamines and steroids only as add-ons
- Observe for hours, prescribe two auto-injectors, refer to an allergist for venom immunotherapy
Red flags
- Stridor, hoarse voice or throat swelling
- Low blood pressure, fainting or confusion
- No response after two doses of epinephrine
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Related guides
Sources: NASEMSO National Model EMS Clinical Guidelines; NREMT psychomotor skill sheets (EMT and Paramedic); National EMS Education Standards (2021). Written by Making Synapses. Making Synapses is not affiliated with these organizations.