Plan & Prepare

Insect Bites and Stings

Insect bites and stings can range from bothersome, itchy rashes to painful skin reactions. While it is often challenging to identify the culprit insect, the outcome bite or sting is rarely dangerous. With some simple prevention and treatment measures, you can avoid an uncomfortable trip.

There are certain insects that can cause severe pain from their bites and stings. These can sometimes lead to dangerous conditions, but fortunately these insects are easily identifiable. A little preparation goes a long way to avoiding a painful encounter.

Anyone with a known bee or wasp allergy should carry an EpiPen in the outdoors and be familiar with how to use it. These can save a life.

Symptoms and Description

Insect bites and stings usually itch. The swelling and redness comes from the body’s local reaction. While this can be annoying, most symptoms are easily treated with cool compresses and over-the-counter medications that bring rapid relief.

Insect bites or stings sometimes lead to a full body allergic reaction. Treatment is based on the severity of the symptoms but rarely requires a trip to the hospital.

The swelling and redness from an insect bite or sting may appear to be similar to a skin infection, and in fact, some insect bites can eventually lead to a skin infection. Draw a line around the outer rim of redness to help you track if the redness is spreading (which may indicate an infection). An area that merely stays swollen and itchy without spreading is more indicative of a local reaction from an insect bite or sting.

Some insects can cause extremely painful or even dangerous reactions. These can progress quickly, so early awareness is important.

Some illnesses can also result from infectious organisms carried by an insect and transmitted during a bite. These systemic illnesses usually manifest days to weeks later. Attention to specifics of the type of rash is often the key to diagnosis and treatment once you have returned home from your trip.


  • Itchy red swelling
  • Painful bump which may have a splint-like stinger in the middle
  • Full body allergic reactions that can lead to diffuse patchy redness and itching, mouth swelling, or even difficulty breathing
  • Severe pain, burning, or numbness after a sting

Guidelines for Safe Travel

Your risk of a severe reaction to an insect bite or sting is often based on a prior reaction. If you have a history of severe itching and skin reactions or other severe allergic reactions, consider traveling with treatment medications.
Your risk of insect-borne diseases is based on the types of insects found in your area.

Insect Bites

  • If a history of severe itching or allergic reactions to insects, travel with over-the-counter medications like ediphenhydramine and / or cetirizine.
  • Limit outdoor time around dusk and dawn when mosquitos and other biting insects are most active.
  • Wear long pants, long sleeves, and a hat in mosquito country. Consider a mosquito net over your hat in heavy insect exposure areas.
  • Use a chemical deterrent spray such as DEET or picaridin. Many different formulations are available. To find the spray that is right for you, refer to the Environmental Protection Agency’s Repellant Selection Tool. Do not apply spray to areas covered by clothing. If you are also using sunscreen, apply sunscreen first and then apply chemical deterrent.
  • Pretreat clothing with permethrin if you anticipate heavy insect exposure. Refer to product information for application instructions.
  • Sleep within a screened enclosure (tent, screen windows, or under a bug net).
  • Perform daily skin checks for new bites or embedded ticks.
  • For international travel, refer to the CDC Travel Resource to assure you have appropriate vaccinations against diseases that can be transmitted by insects.

Bee & Wasp Stings

  • If you or anyone in your party has a history of severe allergic reactions or anaphylaxis, carry a doctor-prescribed EpiPen and know how to apply it.

Scorpions & Spiders

  • In scorpion territory, shake out sleeping bags, clothes, and footwear before using.
  • Avoid blindly reaching under rocks, logs, debris, or underneath objects.
  • Children are at higher risk for progressive and severe symptoms. If a child has been bitten or stung, evacuate to a hospital for observation.

Bee & Wasp Stings

Bee and wasp stings are not subtle. There will be instantaneous burning pain followed by swelling, itching, pain, and redness to the sting site. The redness and pain can spread and persist for 1-2 days.

While single stings are painful, multiple stings can lead to nausea and vomiting, diarrhea, shortness of breath, or even passing out.

Allergic reactions to bee or wasp stings can be mild with nausea and vomiting, itching, swelling to the mouth, or difficulty breathing. Fatal allergic reactions from anaphylaxis usually occur within the first 1-2 hours of being stung.
Have you or a companion been stung? If yes, see medical assessment below.

Treatment Options

  • Apply ice packs, cold running water, or over-the-counter pain medicines to relieve the pain of the sting.
  • If there is an embedded stinger (looks like a little splinter) in the center of the sting, remove it as soon as possible. Take a sharp edge of a knife or forceps and scrape it out of the skin. Try to avoid pinching it with tweezers.


In North America, the most dangerous sting is from the Bark Scorpion. This small yellowish-brown scorpion is found in dry desert areas of the Southwest.

Scorpions are most active in the evening and night, but they may be active during the day during cooler months. Scorpions are often found burrows, debris, cracks in rocks, and tree bark or roots.

The sting causes immediate burning pain, which may feel worse when you tap on the site.

Symptoms from the scorpion toxin symptoms may be progressive, and they can impact breathing and bodily functions. These symptoms may require intensive care unit level medical support, especially for young children.


  • Local burning pain
  • Redness and swelling
  • Increased sweating
  • Drooling
  • Muscle spasms or seizures
  • Breathing difficulties
  • Collapse

Treatment Options

  1. Apply ice packs, cold running water, or over-the-counter pain medicines to relieve the pain of the sting.
  2. If there is an embedded stinger (looks like a little splinter) in the center of the sting, remove it as soon as possible. Take a sharp edge of a knife or forceps and scrape it out of the skin.
  3. All scorpion stings in children should be evacuated and observed in a hospital setting as symptoms can progress.
  4. In an adult, any symptoms more severe than local burning pain at the sting site should be evacuated to medical care for further observation.

Black Widow Spiders

The most dangerous spider found in North America is the black widow spider. Envenomation from its bite can cause substantial pain and illness. The black widow is a glossy black spider with a red dot or hourglass shape on its back.

Black widows live in dry and hot areas and often are found under debris, brush, woodpiles, rocks, or corners of cabins.

A black widow bite feels like a pinprick, and envenomation may result in local pain and muscle cramps in the bitten extremity. Discomfort can also spread to the chest and abdominal muscles with severe, excruciating muscle spasms. Severe painful muscle spasms usually begin within the hour and can progress in intensity. Most severe pain occurs within 8-12 hours but can last several days. Severe envenomation may require evacuation to the nearest emergency department.


  • Local burning pain
  • Redness and swelling
  • Nausea and/or vomiting
  • Dizziness
  • Shortness of breath

Treatment Options

  1. Control local pain, swelling, and redness with over-the-counter pain medicines and cold compress or cold water to the bite site.
  2. Clean bites well with soap and water.
  3. If there is an embedded stinger (looks like a little splinter) in the center of the sting, remove it as soon as possible. Take a sharp edge of a knife or forceps and scrape it out of the skin.
  4. Envenomation symptoms may be more severe for pregnant women and children. Evacuate and observe in a hospital setting for symptom control and possible anti-venom.

Emergency Red Flags

Keep an eye out for the following symptoms. These red flags may be cause for prompt evacuation, especially as some conditions can progress in severity and become debilitating.

  • System-wide (whole body) symptoms of an allergic reaction from a bite or sting
  • Pain from an insect pain or sting that is worsening in severity, especially from a spider bite,
  • Scorpion stings in children or any systemic symptoms in an adult should be evacuated immediate, as symptoms may progress over 6-8 hours.
  • Use extreme caution with black widow spider bites if you are more than an hour away from medical care. Symptoms may progress in severity which may leave the individual unable to walk on their own and necessitate a rescue.
  • Any children or pregnant women bitten by a black widow should be evacuated in a local emergency department.

Are you concerned about an insect bite?

Download GOES to launch a digital medical assessment or speak with a wilderness medicine physician.