Prevention is key:

  • Air flow even a slight breeze makes it harder for them to fly

  • Light-colored pants, long-sleeved shirts, and hats.

Repellents:

  • DEET (N, N-diethyl-meta-toluamide) is the most well studied, and most effective, broad-spectrum repellent. A product with 7 to 10% concentrations of DEET lasts up to 90 minutes and up can always reapply. A 20-30% concentration will last several hours of protection from mosquitoes and ticks. DEET in lotion or wipe form is also just as effective as a spray and removes the risk of inhaling it.

  • Picaridin is the newest option that is odorless, non-greasy, and does not dissolve plastics or other synthetics such as Cutter Advanced, Sawyer Premium, and Repel Smart Spray.

  • PMD (P-menthane-3,8-diol). PMD is a component of lemon eucalyptus extract that has been shown to have effectiveness and duration of action similar to DEET.

  • Icaridin may require more frequent application than DEET to maintain effectiveness, especially at concentrations below 20%.

Normal symptoms:

  • Sharp or burning pain

  • Swelling

  • Redness

  • Itching

Symptom Development (Typical):

  • The swelling and pain usually improve within a few hours.

  • Severe redness and swelling ( >4in = roll of toilet paper) occurs about 10% of the time after a sting.

  • The area will expand for 1 to 2 days and then slowly resolve over 5 to 10 days.

Treatment: All medications below are available over the counter.

  • Yes, remove the stinger immediately… if possible.

  • Clean it with a mild soap and cool or tepid water

  • Apply ice compress ASAP and continue 3x day for 20 min for the 1st 48 hours, if needed.  Be sure to place a layer of cloth or a paper towel between the cold and your skin. No need to deal with frost bite too!

Other Symptoms:

  • Itching or Allergic reaction: take an antihistamine.

  • Cetirizine/ Zyrtec 10mg daily, Claritin 10mg daily, Allegra 180mg daily, diphenhydramine/ Benadry 25-50mg every 6-8 hrs (will cause drowsiness and can increase your risk of falling, 300mg is the maximum dose in 24 hrs).

  • Pearl, Liquid diphenhydramine/ Benadryl (12.5.g/5mL children’s) will be absorbed the fastest.

Swelling: Elevating the area (above your heart, if possible). Keep that ice going, it really makes a difference.

Discomfort:

  • Acetaminophen/ Tylenol (1000mg 3x day – maximum 3000mg in 24hrs)

  • NSAIDs (helps with swelling too) with ibuprofen/ Advil (400mg every 6-8 hours – maximum 2400mg in 24hrs) OR Naproxen/ Aleve 1-2 tabs 2x day

    • IMPORTANT: PLEASE AVOID NSAIDS if you are taking warfarin/ Coumadin, Apixaban/ Eliquis, dabigatran/Pradaxa, rivaroxaban/Xarelto, clopidogrel OR if you have a diagnosis of chronic kidney disease (eGFR < 60) or heart failure.

    • All NSAIDS should be taken with FOOD and an 8oz glass of WATER.

Itching mild: Do not apply to an open wound/skin or concern of infection.

  • Calamine lotion will provide a cooling sensation and relives itchiness and redness. Start immediately and can apply up to 4x a day.

  • Steroids – Hydrocortisone 0.5 -1% or clobetasone 0.05% 2x day for max 1week.

    • Application is more useful for reactions that last longer than a day.

 

For more severe reactions:

  • Add famotidine/Pepcid 20mg 1-2x daily – also a histamine blocker

  • Increase cetirizine/ Zyrtec 10mg to 2x day

  • Albuterol for shortness of breath (monitor your oxygen level with the finger probe).

  • You can outline the redness area with a sharpie marker to track the progression

 

Other considerations:

  • Infections can develop, please contact SMA with any concern, increase redness, swelling discharge.

 

When to call 911:

  • Trouble breathing

  • Swelling of the lips, face, eyelids or throat

  • Dizziness, fainting or unconsciousness

  • A weak and rapid pulse

  • Expanding Hives

  • Nausea, vomiting or diarrhea

  • Severe Allergic reaction (aka anaphylaxis) must be managed immediately with intramuscular epinephrine 0.3mg autoinjector, which may be repeated one in 5 to 15 minutes.

  • Do not drive yourself to the hospital, ask someone else to drive you. Calling 911 is much safer.

Other Important Numbers and Info:

  • Poison control centers are staffed 24-hours a day and can be reached at 1-800-222-1222.

  • Removal of ticks within 24 hours of their attachment may also decrease the risk of tick-borne diseases. Daily checks when traveling in tick prevalent locations are a must. Pay particular attention to the warm, moist corners below the waist where ticks love to hide. Further, ticks require moisture to survive and will rapidly desiccate and die in dry conditions. Run tick-exposed clothes in the dryer for 10 minutes on high and crisp’em to death. Don’t forget those dogs either!

  • Great identification pics: https://www.prevention.com/health/g33011148/common-bug-bite-pictures/