Bee stings are common and painful and cause about 17 deaths per year in the United States. Most information on the immediate treatment of bee stings advises that the stings should be scraped off-perhaps with a knife blade, credit card, or fingernail-and never plucked out by pinching with forceps or fingers. However, the structure of the bee sting apparatus caused Visscher, Vetter, and Camazine (1996) to doubt the soundness of this advice, especially since scraping off a sting with a tool takes longer than simply brushing or pinching it off. They tested the relative envenomization resulting from these two means of removing stings and the effect of short delays in sting removal.
The sting detaches from the body of a honey bee (Apis mellifera) after stinging humans, taking with it the entire distal segment of the bee's abdomen, along with a nerve ganglion, various muscles, a venom sac, and the end of the insect's digestive tract. The sting itself consists of two lancets with curved barbs on the outer aspect of their distal end, held in grooves on the stylet. Muscular movements of the detached sting, coordinated by the attached nerve ganglion, move the stylets alternately. The barbs provide one-way traction, so that the sting continues to work itself deeper into the flesh. A valve and piston on the proximal ends of the moving lancets pumps venom from the sac between the stylet and the lancets, and through an opening near the tip into the wound.
All stings in this study were self-administered by the authors. They collected a worker honey bee as she flew from her hive, grasped her by the wings, and pressed her against the skin of the inside of the volunteer's forearm until she stung.
To assay the venom injected by a bee sting, the area of the weal raised on the forearm after the sting was measured. In preliminary observations, the raised white weal achieved its maximum size about 10 minutes after the sting. Measurements were blind; the observer was unaware of the treatment administered. Ten minutes after each sting was administered, the observer measured the maximum and minimum diameters of the raised portion of the weal, using a digital caliper.
Increased venom dose led to larger weal sizes. There was a significant increase of weal area with increasing time from stinging to removal. The weal area in response to stings removed by scraping was greater than that of stings removed by pinching, but the difference was not significant.
The method of removal does not seem to affect the quantity of venom received. This finding contrasts sharply with conventional advice on the immediate treatment of bee stings. Probably this advice derives from a misunderstanding of the structure and operation of honey bee stings. The sting continues to inject venom, but it is the valve system, not contraction of external compression of the venom sac (the wall of which contains no muscle) that pumps the venom.
The advice should be simply to emphasize that a bee sting should be removed as quickly as possible. Of course the most important response to bees defending their nests should be to get away from the vicinity of the nest quickly. An alarm pheromone is emitted at the base of a honey bee's sting. When detected by other bees it makes them more likely to sting and aids them in locating the victim. In such a situation, reaching safety is more important than removing the stings immediately.
Visscher PK, Vetter RS, Camazine S: Removing bee stings, Lancet 348:301-302, 1996.
See Chapter 18 in Nursing Care of Infants and Children, 5th and 6th editions.
See Chapter 30 in Essentials of Pediatric Nursing, 5th edition
March 15, 2002