Insect Stings & Tick Bites: When to Worry and What to Do
- Victoria Wermers, RN,MSN,FNP, PMHNP
- Sep 25, 2024
- 16 min read
Updated: Jul 1
Bee and Wasp Stings-Tick Bites-Mosquito Bites: Insect Identification, Effects and Treatment Approaches
Common stinging and biting insects include honey bees, wasps, hornets, mosquitoes, yellow jackets, spiders, and fire ants (usually southern states). Often, when people come to the clinic with a small, inflamed puncture wound, they cannot identify the insect that did it. Because of this, it can be tough to determine the course and treatment of the bite or sting. I know it is not always possible, but if you seek treatment, try to identify the culprit (bring it along to the healthcare provider if you can!). It may help determine the kind of treatment you need.
Here are some general guidelines to help you determine the type of insect that did it and various approaches to treat and care for the wound (sometimes people do not even feel it when they get stung, they only see the swelling afterward!).
First, identify it if you can. The following is a very useful site published by the University of Maryland Extension Program to go to for identification: ID yellow jackets, wasps and hornets
Bee Stings
There are many kinds of bees. Bumble bees, honey bees, and African killer bees, to name a few. Yes, there are African Killer bees in the US. They are called killer bees because they are aggressive and attack in large swarms (sounds like clickbait or one of those popular headlines the news puts out there to creep people out).
The honey bee is the most common type of bee. It is generally not very aggressive unless provoked or in unfavorable conditions. Usually, bee stings are just somewhat painful, and there is mild swelling. A honey bee leaves the stinger behind and dies after it stings you(it usually works its way out of the skin).
Wasp Stings
There are many types of wasps and hornets (hornets are a type of wasp). One wasp we are most familiar with in the United States is the yellow jacket. The pain and local reaction to a wasp sting is typically worse than a honey bee sting, and they can sting more than once. A localized red, painful, and burning hive-like welt in the area is a characteristic of this sting. Wasps do generally not leave a stinger in your skin, but can sting you repeatedly. A hornet sting is more painful than the sting of most wasps. Treatment here is the same as when treating a bee (see above). While most insect stings cause mild, localized symptoms, some can lead to severe allergic reactions or toxic responses. This guide—Insect Stings & Tick Bites: When to Worry and What to Do—offers practical advice to help you recognize warning signs and respond appropriately.
Besides trying to identify the insect, there are other important things to help you determine whether or not to seek treatment:
Ask yourself: How many times were you stung?
Most of the time, if a person gets a sting, two, three, or more, it will hurt. But you can become quite sick if you get stung by several at once. According to the Mayo Clinic, a dozen or more bee stings can make you feel sick with nausea, vomiting, dizziness, and sometimes syncope (passing out), resulting more from toxicity than allergy. The USDA claims that the average person can safely tolerate ten stings per pound of body weight. This means that although 500 stings can kill a child, the average adult could withstand more than 1100 stings. Also, if you have an allergy to the sting of any of these insects, you will likely have trouble with anaphylaxis.
Most Insects do not lose their stingers and can sting multiple times. Other insects, like the honey bee, sting a person, leave the stinger behind (in the skin), and then die. Insects that typically do not lose their stingers include fire ants, wasps/hornets, some bees like carpenter bees, and yellow jackets (usually).
Ask yourself: How bad is the reaction?
For most people, insect stings and bites usually develop some localized pain, which progresses to swelling, redness, warmth, and sometimes itching at the site of the sting. This is a normal response and is typically non-urgent. Depending on the insect, you can EXPECT redness to go away within one to three days (barring any outside irritation like scratching or infection). It should not get worse over days. And it should respond to treatment (see below) within several hours.
Some people do have more profound progressive reactions—increasing pain, development of large welts or hives a spreading rash, or even a life-threatening reaction that can get to the point of anaphylaxis. If this occurs, consider treating with an antihistamine (common: diphenhydramine/Benadryl, or Zyrtec), head to urgent care, or dial 9-1-1 if symptoms are developing rapidly. Beware, reactions can come hours later as well.
The following symptoms may signal the onset of a severe allergic reaction:
Itching, rash, or hives continuing to extend beyond the site of the sting.
Skin flushing
Swelling of lips, tongue, and throat, hoarseness
Shortness of breath, wheezing, chest tightness
Dizziness, syncope (fainting)
Stomach problems such as nausea, vomiting, diarrhea, and abdominal pain
Rapid heart rate
The feeling of anxiety, a sense of doom
Word of caution -
If you are allergic to one type of stinging insect (above), you may be more sensitive to similar ones.
For those with known insect allergies, carry an epi-pen when these insects are out and about.
Insect Stings & Tick Bites: When to Worry and What to Do: General Approaches to Bites and Stings
A bee often leaves a stinger and possibly a tiny venom sac in your skin, which looks like a pinpoint black dot. If you see this and want to try to get it out, you can usually just 'scrape' it away with a hard piece of plastic (i.e., a driver's license or credit card). Wash it with soap and water, and put wrapped ice on it as soon as possible - every three to four hours for 15 minutes at a time, to calm the swelling and pain. If it is on an arm or leg and it is swollen, you can also elevate it on a pillow. This can usually be managed at home unless it is severe.
If you have not had a tetanus vaccination within ten years, a tetanus shot is recommended for any sting, primarily because you have a break in the skin.
Mild to Moderate Reactions to Stings and Bites
Conventional Over-the-Counter Approaches
Topical for itching, swelling, and rash
Hydrocortisone Topical on and around the inflamed area
Calamine or Caladryl topical on and around the sting or bite
Anesthetic - Which helps numb the area (common: Dermoplast), Lidocaine gel, ointment or spray on or around the bite or sting (helps numb area)
Oral Medicine for Itching, Swelling, and Rash (highly recommended)
Oral Antihistamine - (common: Benadryl (diphenhydramine), Zyrtec/cetirizine, or Allegra/fexofenadine)
FOR SWELLING AND PAIN (you can take this with antihistamines)
Anti-inflammatories: /NSAIDS - Ibuprofen (Advil or Motrin) as directed over the counter, or Naproxen (Naprosyn) or Acetylsalicylic acid (Aspirin)
Adding Cimetidine (Tagamet) may help if the area is large (bigger than a half-dollar). This antihistamine (also known to help treat stomach problems) helps the antihistamine work more effectively.
*Note: The above creams or ointments should not be applied to open areas (they can introduce infection)
Alternative and Natural Remedies (Local Reactions Only)
Lemon Balm- Topical
Apple Cider Vinegar - Topical - especially for bee stings. Neutralizes venom, so it decreases pain.
Tea Tree - Apply to the area
Holy Basil - Topical
Honey - Ideally, Manuka or raw - apply to the sting or bite. Cover for 1-2 hours.
Baking Soda - Make a paste and spread on a bite or sting - leave on 10-20 minutes 2-3 times per day
Arnica -Topical gel. Has anti-inflammatory properties
Turmeric - Make a paste and apply it for 30 minutes
Unseasoned meat tenderizer -Make a paste and spread it on the area. Leave on for 10-20 minutes. There is papain (from the papaya plant) in some meat tenderizers, which may act as an anti-inflammatory from papaya.
Prescriptive Treatment of Insect Bites and Stings
Healthcare providers generally do not prescribe medication for mild to moderate Insect reactions because over-the-counter treatments typically work well, but if the reaction is more extensive, a provider might give an injection of diphenhydramine/Benadryl or corticosteroids (oral or injection) (common: Prednisone or methylprednisolone, or dexamethasone).
If anaphylaxis occurs, epinephrine is most often used.
Infections of Insect Bites and Stings
Most of the time, the inflammation of an insect sting or bite is not due to infection and does NOT require an antibiotic. However, an infection can develop within about 48 hours because the wound creates an entryway for bacteria (excessive itching can also break the skin and introduce bacteria).
Watch for the following signs and symptoms of infection: increased inflammation/swelling, warmth, fever, red streaks from the lesion, and pus developing over a few days. See bacterial skin infection. If you develop what you may be an infection, see a healthcare provider - especially if you have any risk factors. The provider can evaluate whether or not you need an antibiotic.
First Line Antibiotics for Infected Stings and Bites
Keflex
Dicloxacillin
Severe insect Bites and Stings
If a person is rapidly developing any of the following, they need to call 911. Swelling of the throat and the tongue, and problems swallowing. Tightness in the chest, difficulty breathing, or wheezing are severe symptoms requiring immediate attention. Other symptoms like hives, itching, and swelling in different areas of the body other than that of the sting or stomach symptoms, cramping, nausea, vomiting, or diarrhea may also indicate impending anaphylaxis, which needs to be urgently treated.
For individuals with known severe allergic reactions and anaphylaxis, it is essential to have a healthcare provider prescribe an EpiPen (epinephrine) to carry around; They need to be familiar with its usage. While these devices may be costly, their presence can be the difference between life and death. If a person has an EpiPen, they must use it immediately.
Tick Bites
First, if you find a tick on your body, don't freak out.
Luckily, we do not live in a part of the world where there are a lot of arachnid-borne diseases. Unfortunately, we do have many cases of tick-borne diseases in the US, and the incidence is growing. In fact, the CDC estimates that there are approximately 46,100 tick-borne illnesses in the US every year. Ticks are just creepy.
Ticks usually appear from mid-March until around November, depending on the type of tick. As long as it is above freezing, they can appear. They do not die in the winter; they go dormant.
According to the NIH, there are about 900 species of ticks worldwide. Of these, only about 25 types cause disease. Ticks are vectors: They pick up diseases (viruses, bacteria, and parasites) from one animal and spread them to another. Since certain diseases are specific to certain ticks, if you get a tick bite, it is important to isolate and save the tick to identify it, if possible, so that appropriate treatment(s) can be given.
What to Do if You Find a Tick on Your Body
Use sharp tweezers and grasp the tick at its head, as close to the skin as you can
Grip well and pull straight outward - do not twist.
Clean the area well with rubbing alcohol.
Put the tick in a plastic bag (seal well) or put it in some alcohol in a small container. You can also throw it in the toilet, but before doing so, try to take a picture of its back so that you can identify it later if you get sick. Note its size as you remove it. Is it large or very small? How long do you think it has been on your skin? Think back to when you last were in the grass or trees. Or, perhaps it is from your dog.
DO NOT TRY TO REMOVE THE TICK WITH A MATCH OR PETROLEUM JELLY - IT OFTEN WILL NOT BACK OUT AND SOMETIMES PUTS MORE OF ITS TOXINS UNDER YOUR SKIN. (Yes, we used to try that).
The Mayo Clinic website has a very helpful tick identification chart. Certain ticks are characteristic of various regions of the United States.
What Ticks Do You Have in Your Area?
In the eastern part of the US and along the coastal regions of California, the American dog tick (also known as the wood tick) is known to transmit Rocky Mountain spotted fever and ehrlichiosis.
Eastern part of the US: The black-legged tick, better known as the deer tick, can transmit Lyme disease, Babesiosis, Powassan disease, and anaplasmosis.
East of the Rocky Mountains, especially in New England, the northern Midwest, and near the Great Lakes, the groundhog or woodchuck tick is found in the United States and transmits Powassan disease.
From the mid-Atlantic region to Louisiana, the Gulf Coast tick transmits a form of Rocky Mountain Spotted Fever.
East of the Rockies—The Lone Star tick is another tick found in many states east of the Rockies. It can transmit ehrlichiosis, tularemia, and the heartland virus. The Lone Star tick can also trigger an ongoing allergy to pork, beef, lamb gelatin, and sometimes even dairy—Alpha-gal syndrome.
Common Tick-borne Illnesses
Lyme disease (bacterial) is the most common of these, contributing to 82% of tick-borne illnesses and 476,000 cases yearly. These include Babesiosis (parasite), Ehrlichiosis (bacterial), Rocky Mountain Spotted Fever (bacterial), anaplasmosis (bacterial), Southern Tick-Associated Rash Illness (STARI)(bacterial), Tick-Borne Relapsing Fever (bacterial), and tularemia (bacterial). Some people get tick bites and never get sick, but for others, they can have lasting effects; they can be severe and sometimes fatal.
Again, if you are bitten, it is essential to determine the particular tick's appearance. Where did you pick it up? You likely did not feel it as it burrowed into your skin, but do you have any clue how long it may have been on you (i.e., how big was the tick when you found it? Was it bloated? Was it gray or brown?)? Knowing these things will help determine the possibility of tick-borne illness.
It is doubtful that a tick you found just walking on you or one that just became embedded will transmit disease. The ticks mentioned above must be embedded for at least 24 hours to transmit disease.
If you are developing a tick-borne illness, symptoms begin within three days to three or four weeks. Fever, headache, and rash are some of these characteristics. A "bulls-eye" rash (erythema migrans) often appears at the bite site of a person with Lyme disease. Rocky Mountain Spotted fever rash can be accompanied by a red "splotchy" rash or a rash on hands and feet. Ehrlichiosis can also be manifested by a "splotchy" rash. However, some people do not get a rash at all when they develop these illnesses.
You need to talk to a healthcare provider if you have a rash after a tick bite.
Different types of tick diseases cause different symptoms. But, in general, if the following symptoms occur after a tick has bitten you, tick-borne illness is something to consider. In most cases, the sooner you treat it, the better off you will be.
Symptoms of Tick-Borne Illnesses
Facial nerve palsy or muscle weakness, and paralysis
Fever and chills. fatigue
Malaise
Headache.
Rash - This does not always present as a bullseye rash
Muscle and joint pain.
Stiff neck
Difficulty thinking or concentrating
stomach pain, vomiting
Seizures (Powassan)
Lymph node swelling
flu-like symptoms (Babesiosis)
A Note About An Unusual Tick Allergy:
The lone star tick can also trigger an unusual allergic reaction, Alpha-gal. The victim develops an allergic reaction when eating pork, beef, lamb, gelatin, and sometimes even dairy. The reaction can be severe, to the point of anaphylaxis. This syndrome cannot be reversed, but the symptoms can be contained by avoiding certain foods and using antihistamines, corticosteroids, and epinephrine in the case of a severe reaction (anaphylaxis).
Blood tests can be done to check for antibodies to many of these illnesses.
Insect Stings & Tick Bites: When to Worry and What to Do- Treatments for Tick Bites
Remove the tick!
Cleanse with rubbing alcohol.
Doxycycline (an antibiotic) can be effective for Lyme disease, Rocky Mountain Spotted fever, anaplasmosis, and ehrlichiosis if started within 36 hours of the bite. Other antibiotics are used for Babesiosis. Most others are treated supportively (that is, treat for symptoms as they arise).
More information about tick bites and tick-borne illnesses can be found here.
Prevention of Tick Bites
Use insect repellants:
DEET Repellants (50% DEET or lower) - May corrode synthetic fibers and plastics. It does work, but is banned in Europe because of potential neurotoxicity. In the US, it is EPA-registered and considered safe when used as directed. It repels ticks.
Picaridin-containing products - especially
-EPA-registered Sawyer Premium Insect Repellant 20% Spray Pump (ConsumerLab recommendation) (ConsumerLab will usually let you sign up for a limited trial version)
- Ready Ranger Picaridin Insect Repellant Spray-Scent Zero (ConsumerLab recommendation)
Many sources consider Picaridin safer than DEET.
Permethrin is for the treatment of clothing only (treat shoes, clothing, and areas of exposed skin). This immobilizes ticks.
Herbal oils - Many of these herbal oils claim tick-repellant activity. Apparently, some work really well, but if you are an avid outdoorsman, you may want to do some serious research before using one of these:
Non-chemical ideas: Eat garlic, beans, tomatoes, chili peppers, onions, and apple cider vinegar
Wear pastel colors
Always check for ticks after you have been in the woods!!
Wash clothing with hot water after being outdoors.
If you've been bitten by a tick, your healthcare provider may prescribe a preventive dose of doxycycline, depending on the situation.
Mosquito Bites and Related Illnesses
People catch mosquito-borne diseases when mosquitoes "inject" infected saliva into the victim's body during a bite. Many cases are discovered in travelers who caught the disease overseas in endemic areas. However, there are a fair number of cases where people have contracted these diseases in the United States.
Many mosquito-borne illnesses like West Nile Virus, Dengue Fever, and Malaria begin with similar symptoms but take different courses in their later stages. In most cases, people with the disease never develop symptoms at all.
Typically, the symptoms begin within 3-14 days of being bitten by an infected mosquito. A rash and fever may appear, as well as headaches, body aches, fatigue, and sometimes stomach problems like nausea, vomiting, diarrhea, abdominal pain, swollen lymph nodes, and severe headaches. The symptoms can go away, or they can progress to the point of severe neurological problems and death.
There are no cures for the mosquito-borne diseases. Depending on the symptoms, treatments are focused on supportive measures (symptomatic treatment) like increased fluids, anti-inflammatories, anti-nausea medicines, and others..
West Nile Virus:
The most common mosquito-borne disease in the Continental United States is West Nile Virus (WNV). The mosquito usually catches it from an infected bird and then passes it on to humans through its bite (although there are other, more obscure ways to get it).
In 2023, the West Nile virus infected nearly 2,400 people in the United States. While it occurred in almost every state in the country, in 2019 it was most commonly found in Arizona, California, Nevada, New Mexico, and Texas (according to the CDC, all of these states had over 30 cases in 2019).
Approximately one in five people get symptoms of West Nile Virus (WNV). Symptoms can last for a few weeks (sometimes much longer). They usually begin with rash and flu-like symptoms like fever, fatigue, headache, body aches, sore throat, stomach problems, and abdominal pain. Vision problems and conjunctival injection (eye redness) may occur.
West Nile can cause severe neurologic problems (encephalitis or meningitis), presenting symptoms such as extreme fatigue, disorientation, tremors, stiff neck, seizures, paralysis, or coma. After recovering from the acute phase, some people continue to have symptoms for years, recognized by tiredness, memory problems, balance issues, or issues with balance or walking, and others.
In the early stages, WNV can be challenging to detect because the symptoms are similar to other viral illnesses. One of the most significant clues to the diagnosis of WNV is when a provider realizes that the victim lives or has traveled to an area rife with mosquitoes and West Nile Virus. There is an antibody blood test that can aid in determining the diagnosis.
If you suspect you have been exposed to West Nile virus, contact a healthcare provider ASAP.
Dengue Fever is another viral, mosquito-borne illness. In 2024, there were 9570 cases of Dengue in the continental US. So far this year (June 2025), 2096 cases have been reported in the US. Only 1 in 4 people with Dengue get symptoms. When they do, the symptoms are flu-like, sometimes with a rash, and are usually self-limiting, lasting about seven days. Occasionally, severe symptoms develop, like excessive fluid retention, liver problems, and excessive bleeding (Dengue hemorrhagic fever). Blood testing can be done to detect Dengue.
Note: According to PubMed/NIH, an alternative remedy might include the herb Andrographis, but of course, be careful—before taking something like this, discuss it with your PCP and read about it.
Like West Nile, contact a healthcare provider if you believe you have been exposed to Dengue.
Malaria - A parasite causes malaria. Mosquitoes get malaria from infected people and spread it to other people. While there are approximately 2000 cases of malaria in the US annually, a majority of cases have been those who contracted it in endemic countries; very few reported cases were transmitted by mosquitoes in the US. Untreated malaria can become severe and sometimes fatal.
Alternative remedies: Possibly andrographis
Prescription medicine from a healthcare provider: Several medications can help treat this, depending on the mosquito species, including chloroquine and hydroxychloroquine.
Prevention: This is also an option for those traveling to endemic countries
More information can be found on the CDC website.
Zika Virus - Zika is a virus. A mosquito contracts Zika by biting an infected person and then passing it on to another. There was a big Zika "scare" in 2015 when 52 US-transmitted cases were recorded (CDC). In 2016, there were 4900 travel-related cases. There have been no recorded US-transmitted cases of this in the US since 2019.
The early symptoms of Zika last two to seven days and, like the others, consist of flu-like symptoms: fever, rash, headache, joint and muscle pain, and red eyes. Zika is particularly harmful to the fetus in pregnancy and but is rarely fatal. Research is ongoing regarding this mosquito-borne disease.
Treatment for Zika is primarily symptomatic - fluids, rest, anti-inflammatories, and antipyretics for any fever.
For more information about the Zika virus, please visit the CDC website.
Skeeter Syndrome
On a rare occasion, I met a patient who developed "Skeeter syndrome" after being bitten by mosquitoes. This is a worse-than-normal reaction to mosquito bites: A person develops bruises, a blister-type rash, or large areas of swelling.
Treatment of Mosquito Bites (excluding disease)
General care of a mosquito bite
Wash the area well with soap and water.
Apply a cold or ice pack wrapped in a thin cloth to help reduce swelling and pain (10 minutes on and 10 minutes off for a total of 30 to 60 minutes).
If the sting is very inflamed and occurs on an arm or leg, keep the arm or leg raised to help reduce swelling.
Don't scratch it! (Itching causes the release of more histamine)
Over-the-Counter Treatments for Mosquito Bites
hydrocortisone cream
Oral antihistamines (diphenhydramine/Benadryl, cetirizine/Zyrtec)
Hydrocortisone
Caladryl (Calamine and diphenhydramine)
Natural Remedies to Help With Mosquito Bites
Baking Soda ( water to make a paste)-helps with itching and inflammation
Prevention of Mosquito Bites
Avoid being around shallow, stagnant water or keeping it in your yard - Mosquito eggs are usually in marshes, ponds, backyard containers, standing water, lakes, children's pools, the inside of tires, birdbaths, and other containers with shallow water. Wear long sleeves and light-colored clothing, and wash clothes you have worn outdoors with hot water
Commercial Insect Repellants:
DEET Repellants (50% DEET or lower) -May corrode synthetic fibers. It is EPA-registered. It may cause a local skin reaction and may be neurotoxic if not used as directed. It has been
banned in Europe because of the potential neurotoxic side effects.
Picaridin-containing products -
These are EPA-approved: Sawyer Premium Insect Repellant 20% Spray Pump (ConsumerLab recommended -Site may require signing up for trial)
Ready Ranger Picaridin Insect Repellant Spray-Scent Zero
Permethrin on clothing only, NOT on skin
Essential Oils:
Many oils claim repellent activity against mosquitoes. Again, if you are an avid outdoorsman, you may want to do some serious research before using one.
Mosquito Bites Q&A
Can AIDS be transmitted by mosquitoes?
No. The AIDS virus cannot live long enough in a mosquito to replicate and cannot enter the mosquito's salivary glands (the glands that hold the material injected into a human). Therefore, AIDS cannot be transmitted by mosquitoes.
