Differential Diagnosis

  1. Fire ants
  2. Lyme disease
  3. Spider bite
  4. Wasp sting

This woman suffered multiple stings from a wasp. Because their stingers do not have barbs, as a bee’s stinger does, wasps are able to sting repeatedly. This is most likely to occur when they’re trapped in clothing (or, in this case, a tent).


  • Wasp venom contains enzymes, small peptides, and amines. Allergens include phospholipases, hyaluronidases, and cholinesterases
  • Some peptides cause histamine release by degranulating mast cells; histamine, along with serotonin and acetylcholine, contribute to the pain associated with wasp stings
  • Anaphylactic reactionscause diffuse urticaria, pruritus, angioedema, bronchoconstriction, respiratory distress, hypotension, loss of consciousness, and cardiac arrhythmias

Pearls for Urgent Care Management and Considerations for Transfer

  • Life-threatening, anaphylactic signs typically occur within 10 minutes of the sting. Patients who present days or even hours after a sting should receive symptomatic treatment geared toward reducing discomfort
  • Wash the area of the sting with soap and water to remove as much venom as possible
  • Apply cold packs to reduce swelling and pain
  • Keep the wound clean and dry to prevent infection
  • A bandage may be used to cover the wound
A 34-Year-Old Woman with an Unidentified Insect Sting
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