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Three Part Question

In [patients with bee stings] is [removing the sting by scraping better than removing by pinching] at [reducing localized reactions in the patient]?

Clinical Scenario

A 42 year old woman attends the emergency department after having been stung by a bee on her shoulder. You examine her and find marked local reactions. The woman tells you that she used tweezers to remove the sting. You wonder if the method of removal might have affected the reaction to the bite.

Search Outcome

259 papers were found of which only 1 was relevant. This paper is summarised in the table.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Visscher 1996 USA	1)Two volunteers with 20 self-administered bee stings each, for which the sting was removed after 2s by scraping with the edge of a credit card versus by pinching the sting between thumb and finger and pulling it out. 2)One volunteer with 50 self-administred bee stings in which the sting was removed by scraping after 0,5s vs. 1s vs. 2s vs. 4s vs. 8s	Within subjects design	Size of the weal (mm²) after 10 minutes	1)The method of removal did not significantly affect the weal size (scraping: mean 80 [SE 5.9] mm²; pinching:mean 74 [SE 5.1] mm²; p=0.42). 2)Weal size increased significantly with increasing time from stinging to removal (p=0.018).	Study with only two subjects, serious risk of carry over effects

Comment(s)

When scraping, the sting broke on multiple occasions. This did not occur with pinching.

Editor Comment

SC

Clinical Bottom Line

This study suggests that removing the sting as soon as possible after the bite is more important than the method of removal.

Level of Evidence

Level 3 - Small numbers of small studies or great heterogeneity or very different population.

References

1. Visscher PK, Vetter RS, Camazine S Removing bee stings. Lancet 1996; 348: 301-302