Insect stings from bees, wasps and hornets account for a significant proportion of summer pharmacy consultations across England. Most reactions are localised and manageable with over-the-counter treatments, but a small proportion escalate to systemic allergic responses requiring emergency intervention.
Community pharmacists — with 13,147 registered branches across England according to NHS Digital data tracked by PharmSee — are frequently the first healthcare professional a patient sees after a sting.
Localised reactions: what pharmacists can supply
The majority of insect stings produce a localised reaction: pain, redness and swelling at the sting site, typically resolving within 48 hours. Pharmacy management includes:
| Treatment | Purpose | Notes |
|---|---|---|
| Cold compress | Reduce swelling | Advise 10 minutes on, 10 minutes off |
| Oral antihistamine (cetirizine, loratadine) | Reduce itching and mild swelling | Non-drowsy preferred for daytime use |
| Hydrocortisone cream 1% | Reduce local inflammation | Short-term use only (max 7 days on face) |
| Paracetamol or ibuprofen | Pain relief | Standard OTC doses |
| Sting relief spray (lidocaine-based) | Topical pain relief | Available without prescription |
For bee stings specifically, pharmacists should advise patients to remove the stinger by scraping sideways with a flat edge — not by squeezing with tweezers, which can inject more venom.
Large local reactions
Approximately 10% of people who are stung develop a large local reaction: swelling exceeding 10cm in diameter that may worsen over 24–48 hours before gradually resolving over 5–7 days. These are not allergic reactions in the immunological sense but can be alarming for patients.
Pharmacy management is similar to standard localised reactions but may warrant a stronger antihistamine regimen. Consider recommending regular cetirizine or loratadine for 3–5 days rather than as-needed dosing.
Anaphylaxis: the red flags pharmacists must recognise
Systemic allergic reactions to insect stings affect an estimated 3% of adults stung by hymenoptera (bees, wasps, hornets), according to the British Society for Allergy and Clinical Immunology (BSACI). Anaphylaxis is a medical emergency.
Immediate 999 referral is required if any of these symptoms develop after a sting:
- Difficulty breathing, wheeze or throat tightness
- Swelling of the tongue, lips or throat
- Dizziness, fainting or collapse
- Widespread urticarial rash (hives) beyond the sting site
- Nausea, vomiting or abdominal pain with skin changes
- Rapid onset (typically within 30 minutes of the sting)
Pharmacists should be prepared to administer adrenaline via an auto-injector if available and if trained to do so. The Resuscitation Council UK guidelines support first-responder use of adrenaline auto-injectors in suspected anaphylaxis.
Adrenaline auto-injectors: what pharmacists need to know
Patients with a known history of anaphylaxis to insect stings should carry two adrenaline auto-injectors at all times. The three brands available in the UK are:
| Device | Doses available | Key technique point |
|---|---|---|
| EpiPen | 0.15mg (junior), 0.3mg (adult) | Hold against outer thigh, press firmly |
| Jext | 0.15mg, 0.3mg | Remove yellow cap, press black tip to thigh |
| Emerade | 0.15mg, 0.3mg, 0.5mg | Unique 0.5mg option for larger adults |
Pharmacists dispensing replacement auto-injectors should offer a technique check at every supply. According to published studies, up to 50% of patients prescribed auto-injectors cannot demonstrate correct use when tested.
Prevention advice for patients
Pharmacists can offer practical guidance to reduce sting risk during summer months:
- Avoid bright colours and floral patterns when outdoors
- Keep food and drinks covered at outdoor events
- Do not swat at wasps — sudden movements provoke stings
- Wear shoes outdoors, especially on grass
- Patients with known venom allergy should consider referral for venom immunotherapy via their GP
When to refer to a GP
Pharmacists should recommend a GP appointment if the patient reports:
- A previous systemic reaction to an insect sting (for allergy testing and auto-injector prescription)
- Repeated large local reactions (possible candidate for immunotherapy referral)
- Sting to the mouth or throat (risk of airway compromise even without allergy)
- Infection signs: increasing redness, warmth, pus or fever 48+ hours after the sting
For patients seeking local pharmacy services, PharmSee's pharmacy finder lists all 13,147 registered community pharmacies in England with opening hours and service availability.
Sources
- British Society for Allergy and Clinical Immunology (BSACI), Venom allergy guidelines
- Resuscitation Council UK, Emergency treatment of anaphylaxis (2021)
- NICE Clinical Knowledge Summary, Insect bites and stings (2023)
- PharmSee pharmacy register data, April 2026 (13,147 registered community pharmacies in England)