Bee and Wasp Sting Identification: Which Stung You

The first clue is whether a stinger is left in the skin. Bees leave the sting and venom sac behind; wasps do not, and can sting more than once.

After that, the nest tells you more than the sting does. University of Kentucky entomology describes paper wasps as building umbrella-shaped nests of paper-like material in protected places — under eaves, gutters and ledges, or in attics, barns and sheds. Hornets build a large grey nest resembling a bloated football, attached to a tree, bush or the side of a building. Yellowjackets nest below ground in old chipmunk or rodent burrows, or under rocks, gutter splash blocks and landscape timbers, and also in stone walls, crawlspaces, attics and behind exterior siding.

Paper wasps have a very thin waist, and the European paper wasp has yellow and black markings much like a yellowjacket, which is a common mix-up.

University of Kentucky entomology explains the seasonal pattern: during late summer and early fall, yellowjacket colonies are nearing maturity and huge numbers of workers are out foraging for food. That is when they turn up at outdoor gatherings, around rubbish bins and on food and drink.

The same source ranks the risk. Yellowjackets are described as arguably the most dangerous stinging insects in the United States and usually sting if the nest is disturbed. Hornets are far more difficult and dangerous to control than paper wasps. Paper wasps are not very aggressive, though stings do happen when their nests are disturbed.

When a nest is threatened, the colony may launch a coordinated assault, which is why multiple stings at once usually mean a nest was hit rather than a single insect defending itself.

The American College of Allergy, Asthma and Immunology sorts sting reactions into three.

• Normal local reaction: pain, swelling and redness confined to the sting site. Clean it with soap and water and apply ice
• Large local reaction: swelling that extends beyond the sting site, so that a sting on the forearm can make the whole arm swell. It usually peaks two to three days after the sting and can last a week or more, and it is not life threatening
• Systemic reaction: hives, itching and swelling in areas other than the sting site, tightness in the chest, difficulty breathing, a hoarse voice or swelling of the tongue or throat. Severe anaphylaxis may cause dizziness, a sharp drop in blood pressure, loss of consciousness or cardiac arrest

The swelling of a large local reaction is alarming but is not, by itself, an allergic emergency. The reactions away from the sting site are.

If a stinger is in the skin, the ACAAI says to remove it by scraping the area with a straight edge such as a credit card, and not to pinch the stinger or use tweezers, because that could release more venom. The NHS gives the same idea with a fingernail.

Then clean the sting with soap and water and apply ice. The NHS adds a cold compress for at least 20 minutes if the area is swollen, pain relief if needed, and antihistamines or hydrocortisone cream for itching, plus the standing advice not to scratch.

For anyone who has been prescribed injectable epinephrine, the ACAAI says to carry it at all times and to seek medical attention immediately after using it. University of Kentucky entomology is equally direct: someone with an allergic reaction should not wait to see if symptoms go away.

The NHS lists the signs of anaphylaxis for which to call emergency services immediately: swelling of the lips, mouth, throat or tongue; difficulty breathing or wheezing; throat tightness; skin, tongue or lips turning blue, grey or pale; confusion or fainting. It also says to get urgent advice if symptoms worsen, if the sting is in the mouth, throat or eyes, if you feel dizzy, have a high temperature, have been stung many times, or have had a severe allergic reaction before.

The scale matters. The ACAAI reports an average of 72 deaths a year from stings in the United States, and that between 1.6 and 5.1 percent of Americans have experienced a potentially fatal reaction. For long-term management it describes venom immunotherapy as giving up to 98 percent protection.

Nothing here is a diagnosis. An allergist is the person who decides whether you need a prescription.