• Bees, wasps, hornets and ants: venom is usually mild and causes only local reaction but may cause anaphylactic shock in previously sensitized persons
  • Spiders and scorpions: Most are non-venomous or only mildly venomous
  • Other stinging insects

Clinical features

  • Swelling, discolouration, burning sensation, pain at the site of the sting
  • There may be signs of anaphylactic shock

Differential diagnosis

  • Allergic reaction


  • If the sting remains implanted in the skin, carefully remove with a needle or knife blade
  • Apply cold water/ice

If severe local reaction

  • Give chlorpheniramine 4 mg every 6 hours (max: 24 mg daily) until swelling subsides
    Child 1-2 years: 1 mg every 12 hours
    Child 2-5 years: 1 mg every 6 hours (max: 6 mg daily)
    Child 6-12 years: 2 mg every 6 hours (max: 12 mg daily)
  • Apply calamine lotion prn every 6 hours

If very painful scorpion sting

  • Infiltrate 2 ml of lignocaine 2% around the area of the bite

If signs of systemic envenomation

  • Consult


  • Clear overgrown vegetation/bushes around the home
  • Prevent children from playing in the bush
  • Cover exposed skin while moving in the bush
  • Use pest control methods to clear insect colonies