Anaphylaxis: bee stings may be removed quickly by scraping or pinching

Clinical bottom line (level 5)

  1. Removing bee stings by pinching rather than scraping did not clearly increase the size of the wheal.
  2. The longer the bee sting remained in place, the greater the size of the subsequent wheal. Stings should be removed quickly - by whatever method.
Visscher et al: Lancet 1996; 348: 301-302
Expires November 2004

The study

Single-blinded ?concealed quasi-randomised trial with intention-to-treat
Setting: entomology department, USA

2 patients who underwent voluntary bee stings (10 per treatment)
Control Group: (n = 20, 20 analysed): sting removal by scraping
Experimental Group: (n = 20, 20 analysed): sting removal by pinching

100% followed for 10 minutes

The evidence

Outcome Control Group
(SD)		 Experimental Group
(SD)		 Mean Difference
(95% CI)
wheal size (mm 2 ) 80
(26) 		74
(23) 		6
(-10 to 22)

  • Wheal size increased the longer the sting was left in place (p=0.018).

    • Comments

    1. Stings were removed from one arm by scraping and from the other by pinching.

    Citation

    1. Visscher PK, Vetter RS, Camazine S: removing bee stings. Lancet 1996; 348: 301-302
    Contributor: Chris Ball and Clare Wotton, November 1999
    Reviewer: Santiago Alvarez Montero

    Clinical Question.
    Patient bee sting
    Intervention or Exposure scraping
    Comparison pinching
    Outcome wheal size