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Person sitting against a tree at a forest edge, companion kneeling beside them with a phone

A severe allergic reaction after a wasp or bee sting outdoors

One sting, and minutes later breathing gets hard or the circulation drops: call 112, use the person's own emergency pen, position them correctly – and do not leave them alone.

First

  1. Call 112 at once (in Austria 144) if breathlessness, swelling of the face or throat, dizziness, vomiting or a rash all over the body appear after a sting.
  2. If the person has their own adrenaline auto-injector (“emergency pen”): help them use it straight away – into the outer thigh, even through trousers.
  3. Positioning: with breathing difficulty let them sit upright. With dizziness or weakness lay them flat and raise their legs. Do not let them stand up or walk around.
  4. Stay with the person and watch them. If there is no improvement after about 5 minutes and a second pen is available: use the second pen. Unconscious and breathing normally: recovery position.

Call emergency services if

  • Breathlessness, wheezing, hoarseness or difficulty swallowing
  • Swelling of the face, lips, tongue or throat
  • Dizziness, pallor, cold sweat, fainting
  • Rash or hives all over the body together with nausea or vomiting
  • A sting in the mouth or throat
  • Many stings at once (e.g. a swarm attack)
  • The adrenaline pen has been used – even if things improve afterwards

Emergency numbers for Austria · Change region

What is happening

A wasp or bee sting hurts and swells – that is normal. In some people, however, the whole body reacts: within minutes there is itching and hives all over the body, swelling of the face, hoarseness, breathlessness, nausea, vomiting, dizziness or a circulatory collapse. This is called anaphylaxis. It is a life-threatening emergency.

The most important medicine is adrenaline. People with a known insect venom allergy often carry an adrenaline auto-injector (“emergency pen”). As a lay person you help them use their own pen: it is pressed into the outer thigh, through trousers if necessary. Better early than too late – for most people the risks of a pen are small compared with an untreated severe reaction.

Positioning is just as important: with breathing difficulty the person usually wants to sit – let them. With dizziness and weakness lay them flat and raise the legs. Standing up or walking suddenly can cause the circulation to collapse. Outdoors, far from the road, an early emergency call is therefore decisive: rescuers need time to reach you.

A sting in the mouth or throat – for example from a wasp in a drink – is dangerous even without an allergy, because the swelling can narrow the airway. Many stings at once are also an emergency.

Step by step

  1. Phase 1

    The first minutes

    • Move away from the nest or swarm, calmly go back a few metres.
    • Remove a bee sting at once – scrape or pull it out, the main thing is speed. Wasps do not leave a sting behind.
    • Watch for signs: hives or redness all over the body, facial swelling, hoarseness, breathlessness, nausea, dizziness.
    • With such signs call 112 at once (in Austria 144) and say “allergic shock after an insect sting”.
    • Ask: “Do you have an emergency pen?” If so – take it out and use it together.

  2. Phase 2

    Pen and positioning

    • Pen: safety cap off, press the tip firmly against the outer thigh, hold for a few seconds (the exact instructions are on the pen). Note the time.
    • Breathlessness: let them sit upright, leaning against a tree or pack. If the person has asthma and a reliever inhaler, they may use it as well.
    • Dizziness, pallor, weakness: lay them flat, raise the legs. Do not let them sit or stand up.
    • Lay pregnant women on their left side.
    • If there is no improvement after about 5 minutes and a second pen is available: second pen into the other thigh.

  3. Phase 3

    Until rescuers arrive

    • Stay with the person, talk calmly to them, watch constantly: breathing, skin colour, responsiveness.
    • Keep them warm but not overheated; protect them from strong sun.
    • Unconscious with normal breathing: recovery position. No normal breathing: start CPR and follow the dispatcher's instructions.
    • In a group: send someone to the nearest path or car park to guide the rescuers in.
    • Give the used pen to the ambulance crew.

  4. Phase 4

    Afterwards

    • After a severe reaction or a pen injection always go to hospital – symptoms can return after a few hours.
    • Anyone who reacted like this for the first time should afterwards see an allergy specialist. There is effective treatment (immunotherapy) for insect venom allergy.
    • Replace the pen and in future always carry two if prescribed.

★ Pro tips

What experienced people do differently: proven practice from mountain rescue, fire services, lifeguards and civil protection that beginners rarely know.

  1. Sting in the mouth: suck ice, cool the neck

    After a sting in the mouth or throat, call for help at once. Until help arrives, the person sucks ice cubes or sips cold water, and you put cold, damp cloths on the outside of the neck. Cold slows the swelling.

  2. Tablets don't replace the pen

    Many people with allergies also carry tablets in their emergency kit. They act much more slowly and don't help against breathing trouble or circulatory collapse. With severe signs, the pen always comes first.

  3. Carry an allergy card where it's seen

    An anaphylaxis or allergy card tells helpers what's going on and where the pen is – even if you can no longer speak. Keep it with the pen, or fill in your phone's emergency medical info, which can be read from the lock screen.

  4. Late summer is wasp season

    In August and September wasp colonies are at their largest and the insects are hunting hard for sugar and protein. People with allergies should be especially careful with breaks and picnics then, and keep the pen on their body.

What to watch out for

  • Standing up after improvement

    If things improve after the pen, many want to stand up and walk to the car. That can trigger another circulatory collapse. Stay lying down until rescuers arrive.

  • Hesitating too long

    Out of fear of the injection the pen is often given too late. With signs of a severe reaction: use it. Waiting is more dangerous.

  • Far from the road

    In the terrain it takes longer for help to arrive. So call early and give your location precisely – if needed a helicopter will come.

  • More stings

    Near a nest, more insects often come. Calmly, without flailing, get some distance before giving first aid.

Common mistakes

  • Waiting to see whether it gets better on its own.
  • Not using the pen for fear of making a mistake.
  • Letting the person stand up or walk to the car.
  • Laying someone flat when they are struggling to breathe.
  • Skipping hospital after the pen has been given.
  • Just waiting after a sting in the mouth.

Prepare in advance

  • Anyone with a known insect venom allergy: always carry the emergency kit (usually two adrenaline pens and other prescribed medicines) on the body or in the lid pocket – not deep in the pack.
  • Show companions before the tour where the pen is and how it works. Training pens without a needle help with practice.
  • Check the expiry date and do not store pens in strong sun or cold.
  • Outdoors drink from bottles with a straw or from clear glasses and look before you drink.
  • At picnics cover sweet foods and meat; do not walk barefoot across meadows with clover.
  • Take a first aid course – there you learn positioning, the recovery position and CPR.

Special consideration

Children
There are pens with a smaller dose for children. Children with an allergy should know where their pen is, and adults at school, in clubs and in the family should be able to use it. A child with breathing difficulty usually wants to sit on a lap – that is fine.
If you are allergic yourself and alone
Use your own pen at once, then call 112, give your location and sit or lie down. Do not set off to fetch help.

Sources

  • EAACI guidelines: Anaphylaxis (2021 update) · Allergy 77(2): 357–377 (A. Muraro et al., European Academy of Allergy and Clinical Immunology), 2022
  • European Resuscitation Council Guidelines 2021: First Aid · European Resuscitation Council – Resuscitation (journal), 2021
  • International First Aid, Resuscitation, and Education Guidelines 2020 · International Federation of Red Cross and Red Crescent Societies (IFRC) – Global First Aid Reference Centre, 2020
  • 112 – the European emergency number · European Commission
  • Notrufnummern (oesterreich.gv.at) · Bundesministerium für Finanzen – Amtshelfer oesterreich.gv.at

Your situation

What signs are there?
Emergency kit
Where was the sting?
Phone signal

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Basics for this situation

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All rules of this situation (8)

  1. [not active] If What signs are there? = Only strong swelling at the sting

    A large swelling only around the sting is usually not a whole-body allergy. Remove a bee sting quickly, cool, watch the person for at least half an hour. If signs appear elsewhere in the body: call at once.

  2. [not active] If What signs are there? = Breathlessness, hoarseness, swelling of face or throat

    Breathing difficulty is life-threatening. Let them sit upright, use the adrenaline pen if available, loosen tight clothing at the neck. If the person has asthma and their own reliever inhaler, they may also use it – the pen comes first.

  3. [not active] If What signs are there? = Dizziness, pallor, weakness, vomiting

    Lay them flat, raise the legs, do not let them stand up – even if it briefly improves. Sitting or standing up suddenly can trigger a circulatory collapse. Lay pregnant women on their left side.

  4. [not active] If What signs are there? = Unresponsive

    Speak to them, check breathing. Normal breathing: recovery position. No normal breathing: start CPR at once and follow the dispatcher's instructions. An available pen may still be given.

  5. [not active] If Emergency kit = Own adrenaline pen with them

    Better too early than too late: the pen is given at signs of a severe reaction, not only when things are very bad. The person ideally uses it themselves while you help hold it. Cap off, press firmly against the thigh and hold for a few seconds – the instructions are printed on the pen.

  6. [not active] If Emergency kit = No pen

    Without a pen, a quick emergency call is the most important thing. Use other people's pens or medicines only if the dispatcher tells you to. Positioning and monitoring until rescuers arrive.

  7. [not active] If Where was the sting? = In the mouth or throat (e.g. wasp in a drink)

    A sting in the mouth or throat can swell enough to make breathing hard even without an allergy. Call at once, let them suck ice or sip cold water, sit upright.

  8. [not active] If Phone signal = No signal

    Without signal: still try 112. In a group, send two people at once to the nearest place with signal or the nearest hut; the affected person stays lying down and is watched.