Skip to main content

Large Local Reactions to Insect Stings or Bites

Frequently Asked Questions

This document has been developed by ASCIA, the peak professional body of clinical immunology/allergy specialists in Australia and New Zealand. ASCIA information is based on published literature and expert review, is not influenced by commercial organisations and is not intended to replace medical advice.         

For patient or carer support contact Allergy & Anaphylaxis Australia or Allergy New Zealand.

pdfASCIA PC Large Local Reactions Insect Stings 202477.14 KB

Q 1: What is a large local reaction to an insect sting or bite?

A large local reaction is an allergic reaction with swelling that is larger than 10cm around the site of an insect sting or bite. These reactions are more common in children than adults.

Q 2: How are large local reactions to insect stings or bites treated?

For insect stings, flick out stinger if visible. Removing a bee stinger as quickly as you can is more important than the method you use. For tick bites, removal of the tick uses a different method.

Most large local reactions do not need any treatment and will often go away (resolve) within hours.       If large local reactions last longer than several hours or are painful, they may need treatment, including:

  • Using a cold or ice pack - may reduce pain, itch and swelling. Ice packs can be wrapped in a towel or cloth before applying and should not be placed directly on skin.
  • Non-sedating antihistamines - can help to reduce itch.
  • Pain medications - paracetamol or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can help reduce pain.

Most large local reactions to insect stings or bites do not need allergy testing or immunotherapy.

If you have had a large local reaction to a sting or bite, and you have another sting or bite, it is most likely that the next reaction will be similar.

Q 3: What needs to be done when there are severe symptoms?

See your GP if the swelling:

  • Becomes worse or larger, hotter and more painful - antibiotics may be prescribed if an infection is suspected.
  • Is very large - corticosteroids such as prednisolone or prednisone may be prescribed.

Call an ambulance (000 in Australia and 111 in New Zealand) if you have:

  • Difficulty/noisy breathing, swelling of the tongue, swelling or tightness in the throat, wheeze or persistent cough, voice change, persistent dizziness or collapse
  • Abdominal symptoms such as stomach pain or diarrhoea, especially in the first hour after the sting.

If it is a severe allergic reaction (anaphylaxis), adrenaline (epinephrine) devices may be given if available. Adrenaline devices are prescribed for people who are considered at risk of anaphylaxis. Adrenaline devices are not usually prescribed for people with large local reactions to stings or bites.

© ASCIA 2024

Content updated November 2024

For more information go to www.allergy.org.au/patients/insect-allergy-bites-and-stings

To support allergy and immunology research go to www.allergyimmunology.org.au/donate