Injection of Lidocaine With Epinephrine for Bee Sting Large Local Reactions

Area of Science:

• Allergy and Immunology
• Dermatology
• Emergency Medicine

Background:

• Large local reactions (LLRs) from bee stings affect 5-15% of individuals, presenting as significant skin reactions with edema, erythema, and itching.
• Current treatments like NSAIDs, antihistamines, and corticosteroids do not provide immediate symptom relief or halt the allergic cascade.
• There is a need for rapid interventions that address both the pain and the underlying allergic and inflammatory responses to bee stings.

Observation:

• A case of a periorbital large local reaction following a bee sting is presented.
• The reaction involved significant eyelid swelling and erythema.
• Standard treatments were not initiated; an alternative approach was employed.

Findings:

• Subcutaneous and intradermal injection of 1% lidocaine with epinephrine into the sting site resulted in rapid symptom reversal.
• Lidocaine effectively alleviated pain and pressure associated with the reaction.
• Epinephrine, administered in a low dose, significantly reduced periorbital and eyelid edema within 2 hours, suggesting termination of the allergic cascade.

Implications:

• Subcutaneous and intradermal lidocaine with epinephrine may offer a rapid and effective treatment for large local bee sting reactions.
• This method potentially provides immediate pain relief and addresses the allergic and inflammatory components of the reaction.
• Further research is warranted to explore the efficacy and safety of this treatment modality in a broader patient population.