A pediatric surgeon can tell they’re getting older when they start leaving the hospital during holidays; it means they’re over 50 now… This year, I finally managed to find time to get away from Istanbul during the holiday. While exploring Gökova, I noticed that there were a lot of bees. As you know, beekeeping is an active livelihood for the people in Muğla. So, I thought I would share with you a common problem that can be encountered in the summer months, which is “bee stings.”

Why do bees sting people?
First of all, let me say this because I love honey and bees: bees don’t sting for no reason. For them to sting you, you would have to step on a bee on the grass with bare feet or unknowingly place your hand on a bee on the table. Or you would need to get very close to the bee’s hive, provoke the bees by poking the hive, or make them perceive you as a threat by making unnecessary fears and sudden movements. Otherwise, bees won’t sting you. Especially honey bees don’t sting unless they are forced to. Why would they sting? If they sting, they die. Why would they kill themselves for no reason?
So, the second question: Why do honey bees die when they sting?
Honey bees’ stingers are surrounded by tiny, barbed structures similar to sea urchin spines or fishhook barbs, which you can’t see with the naked eye. When they penetrate the tough human skin, these barbed structures prevent the stinger from being pulled out. At the end of the stinger, there is a sac filled with the bee’s venom. The stinger and venom sac are also connected to the bee’s internal organs. When a bee stings a person, it cannot retract its stinger, and the sac and stinger remain in the skin. While the bee tries to free itself, its internal organs attached to the sac and stinger are pulled out, and as a result, the bee dies. Here’s a little extra information: In other species of bees like bumblebees, wild bees, and carpenter bees, the barbed structures on their stingers are minimal and only present at the tip. So, these bee species don’t die when they sting and can sting multiple times… But like honey bees, they also don’t sting for no reason.
What happens if a bee stings you?
First, the stinging of the needle stimulates pain receptors, so you will feel pain. Then, we perceive the protein that forms the venom as an allergen, and our immune system’s immunoglobulins called IgE bind to this allergen. This binding of antigen and IgE in our blood triggers the release of histamine from mast cells. Histamine initially increases blood flow, causes inflammation, and leads to the release of certain chemicals in an attempt to neutralize the effects of the venom. This histamine, in its attempt to eliminate all allergens from the body, also causes systemic symptoms such as nasal itching, runny nose, eye discharge, itching, sneezing, and coughing. That’s why we take antihistamines, which are allergy medications when our bodies show such allergic symptoms.
The occurrence of bee stings is estimated to be between 0.3% and 3%, but the exact percentage is uncertain. It is believed that around 8% of the entire population may experience anaphylaxis, which is a severe allergic reaction.
What is anaphylaxis?
Anaphylaxis refers to the spread and systemic manifestation of allergic reactions. It is estimated that about 40 people die from anaphylaxis due to bee stings in the United States each year. People experiencing anaphylaxis can develop widespread hives, swelling of the throat and tongue, difficulty breathing, nausea, vomiting, low blood pressure, and loss of consciousness.
Allergic problems can be present from birth, but some individuals can develop severe allergic reactions later in life. For example, if a bee stings you and your body rapidly produces IgE, and then you get stung by a bee again while there is still a high level of IgE in your blood, a faster and stronger reaction can occur.
What are the clinical problems that occur when a bee stings?
In most people, simple localized reactions occur that do not cause significant issues, such as redness and painful swelling (1-5 cm in diameter). The swelling may develop within the first few hours and last for one to two days.
Approximately 10% of people may experience larger localized reactions with swelling reaching about 10 cm in diameter. This type of reaction is called “large local reactions.” About 8% of these reactions can lead to anaphylactic reactions. As mentioned earlier, these include respiratory distress, low blood pressure, difficulty breathing, and loss of consciousness.
What should we do if someone gets stung by a bee?
As I mentioned earlier, since the bee’s stinger and venom sac remain in the skin, venom continues to be released even after the sting. Therefore, it is important to quickly remove the stinger from the skin. Then, wash the area with water and soap. Afterwards, apply a cold pack or ice wrapped in a cloth to reduce swelling.
If large local reactions develop as mentioned above, medical treatment may be necessary. These patients can use oral/topical steroids, anti-inflammatory drugs, and antihistamines (antiallergy medications) orally or as creams.
It is important to differentiate between large local reactions and bacterial infections. Bacterial infections usually develop 3-5 days after the sting and may be accompanied by fever, but fortunately, they are not commonly observed after bee stings. Antibiotics are not effective for bee stings, and if an abscess forms, surgeons may need to intervene.
The most important point is this: If a person has a known allergic history or exhibits anaphylaxis symptoms as described above, it is necessary to administer epinephrine using an Epipen or similar device. An Epipen is a special syringe containing a pre-measured dose of epinephrine that can be quickly injected into the thigh muscle. Epinephrine narrows dilated blood vessels, increases low blood pressure, and relaxes the muscles of the respiratory system, allowing for easier breathing. However, these individuals must immediately go to the hospital because temporary relief may have been achieved, and the patient can still deteriorate.
The best approach is to be cautious when walking on grass during the summer, avoid walking barefoot in areas where bees are present, avoid wearing brightly colored clothing, and refrain from using strong perfumes. Pay extra attention while eating. Contrary to popular belief, bees are more attracted to meat than sugar. It is best to avoid eating meat, as it is both expensive and harmful. If you must eat meat, do so when the sun has set and there are no bees around. If you have to eat during lunchtime, lighting Turkish coffee can be effective in keeping bees away. Also, avoid drinking from bottles whose contents you cannot see by holding them upright and drinking directly from the bottle. Bees entering tin cans or beer bottles and stinging your throat can have unpleasant consequences.

I think I’ve talked too much. Let’s conclude our conversation without distracting you.
If you want to watch the video click here. Follow me on Instagram and stay happy.
July, 2023
Prof. Dr. Egemen Eroğlu