Bee and wasp sting envenomation and clinical toxicology: a narrative review

Bee and wasp (Hymenoptera) sting envenomation, sometimes life-threatening, is not an uncommon medical emergency, especially in resource-limited settings and rural set-ups. The sting venom is a complex mixture of enzymes, amines, peptides, and kinins. The spectrum of clinical presentation varies from mild non-allergic to severe allergic manifestations associated with significant morbidity and mortality. Mild local reaction, large local reaction, systemic anaphylactic reaction, and occasional systemic toxicity with multiorgan involvement are the usual clinical manifestations. In general, the management remains supportive and includes treatment of local reaction, management of anaphylaxis, and providing organ support to prevent organ injury. Diagnosis and prevention of Hymenoptera venom hypersensitivity is difficult because of a lack of affordable standardized investigations, poor access to advanced diagnostic facilities, and expensive venom immunotherapy. As the exact burden of human suffering from bee and wasp envenomation is unknown, its effective management protocols remain challenging in resource-limited settings. This narrative review focuses on clinical presentation, treatment approaches, and management guidelines for this not so uncommon public health problem of significance.