INSECT BITE

Definition

  • Itchy Insect Bites: Bites of mosquitoes, chiggers (harvest mites), fleas, and bedbugs usually cause itchy, red bumps.  
  • Painful Insect Bites: Bites of horseflies, black flies, deer flies, gnats, harvester ants, blister beetles, and centipedes usually cause a painful, red bump. Within a few hours, fire ant bites can change to blisters or pimples.

Anaphylaxis

  • Anaphylaxis is the medical term for a severe life-threatening allergic reaction.
  • Symptoms of anaphylaxis include: feeling faint or passing out, difficulty breathing, swelling of the tongue, hives, wheezing and/or cough. Onset of symptoms is sometimes within seconds and usually within 20 minutes.
  • Individuals who have had severe reactions to previous stings should have an anaphylaxis kit (e.g. Ana-Kit, Epi-Pen) and keep it nearby if there is any risk of a sting.  
  • Anaphylaxis can occur following fire ant stings, but rarely with other insects.  It mainly occurs with bee, yellow jacket or wasp stings.

>FIRST AID Advice for Anaphylaxis

  • Give epinephrine injection if you have an anaphylactic kit. Inject it into the muscle of the upper outer thigh.

See More Appropriate Topic (instead of this one) If

WHEN TO CALL YOUR DOCTOR FOR INSECT BITE

Call 911 Now (you may need an ambulance) If

  • Passed out
  • Difficult to awaken or acting confused
  • Wheezing or difficulty breathing
  • Hoarseness, cough or tightness in the throat or chest
  • Swollen tongue or difficulty swallowing
  • Previous severe allergic reaction same insect bite. (not just hives or swelling) (Note:  anaphylaxis usually starts within 20 minutes, and always by 2 hours following a bite.)
  • Use First Aid Advice for Anaphylaxis

Call Your Doctor Now (night or day) If

  • You feel weak or very sick

  • Hives or swelling elsewhere on the body
  • Fever and bite looks infected (i.e. spreading redness, pus)
  • Severe pain persists for more than 2 hours after pain medicine

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

  • You think you need to be seen
  • New redness or red streak occurs around the bite after the first 24 hours
  • Scab that looks infected (drains pus or increases in size) not improved after applying antibiotic ointment for 2 days

Call Your Doctor During Weekday Office Hours If

  • You have other questions or concerns

Self Care at Home If

  • Normal insect bite and you don't think you need to be seen
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HOME CARE ADVICE FOR INSECT BITES

  1. Local Treatment - Itchy Insect Bites (including all mosquito bites)
    • Apply calamine lotion or a baking soda paste.
    • If the itch is severe, use 1% hydrocortisone cream.  Apply 4 times a day until the itch is less severe, then switch to calamine lotion.
    • Also apply firm, sharp, direct, steady pressure to the bite for 10 seconds. A fingernail, pen cap, or other object can be used.
  2. Antihistamine for Itching: Take an antihistamine (e.g. Benadryl) for insect bites that are very itchy after local treatment. The adult dosage of Benadryl is 25-50 mg by mouth 4 times daily.
    • Do not take antihistamine medications such as Benadryl if you have prostate enlargement.
    • Antihistamines may cause sleepiness. Do not drink, drive or operate dangerous machinery while taking antihistamines.
    • Read the package instructions thoroughly on all medications that you take.
  3. Local Treatment - Painful Insect Bites
    • Rub the bite for 15 to 20 minutes with a cotton ball soaked in a meat tenderizer solution.  This will usually relieve the pain. (Caution: don't use near the eye)
    • If not available, use a baking soda solution on a cotton ball.
    • If neither is available, apply an ice cube for 20 minutes.
  4. Pain Medication: If local treatment measures do not adequately reduce the pain, take acetaminophen every 4-6 hours (e.g. Tylenol; adult dosage 650 mg) OR ibuprofen every 6-8 hours (e.g. Advil, Motrin; adult dosage 400 mg).
    • Do not take ibuprofen if you have stomach problems, kidney disease, are pregnant, or have been told by your doctor to avoid this type of anti-inflammatory drug. Do not take ibuprofen for more than 7 days without consulting your doctor.
    • Do not take acetaminophen if you have liver disease.
    • Read the package instructions thoroughly on all medications that you take.
  5. Antibiotic Ointment: If the insect bite has a scab on it and the scab looks infected, apply an antibiotic ointment 4 times per day.
    • Cover the scab with a Band-Aid to prevent scratching and spread.
    • Repeat washing the sore, the antibiotic ointment and the Band-Aid 4 times per day until healed.
  6. Expected Course: Most insect bites itch or hurt for 1 to 2 days. The swelling may last a week.
  7. Call Your Doctor If:
    • Severe pain persists more than 2 hours after pain medicine
    • Infected scab doesn't look better after 48 hours of antibiotic ointment.
    • Bite looks infected (redness, red streaks, increased tenderness)
    • You become worse or develop any of the "Call Your Doctor" symptoms.
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Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Adult HouseCalls Online. Copyright © 2000-2003 David Thompson, M.D. FACEP

Reviewed 8/2003

Revised 7/2002

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