It can be difficult to know if a bite or a sting from an insect is dangerous or not. This article explains the best first aid treatment depending on the type of insect involved.

It’s important to be aware that bites or stings from insects can cause a severe allergic reaction (anaphylaxis) in some people. Learn more about first aid treatment for severe allergic reactions in the anaphylaxis section below.

How do I know if it’s an insect bite?

An insect bite will leave a puncture wound in the skin. The type of insect that you are bitten by can determine what type of reaction you will have.

Insect bites will usually clear up in a day or two without any further treatment.

Common symptoms of a bite include:

• skin irritation
• inflammation or swelling
• a bump or blister around the bite mark

How do I know if it’s an insect sting?

If you are stung, the insect will puncture the skin and leave behind saliva, faeces (poo) or venom.

It’s also quite common that the insect will leave behind its 'sting' with or without venom.

Common symptoms of a sting include:

• an intense burning feeling
• redness around the sting site
• pain which generally eases after an hour or so
• swelling around the sting
• in cases of allergic reaction, swelling may be more severe and affect a larger part of the body, for example the whole leg or arm may become swollen
• allergic reactions may cause further swelling, pain and in some cases blisters will form

Stings generally clear up within two days (48 hours) although the area may be tender for a few days after this.

What is itching?

Itching is a common irritation of the skin that makes a person want to scratch the itchy area. It can occur anywhere on the body, and can be very frustrating and uncomfortable.

Itching may occur on a small part of the body, for example around the area of an insect bite or sting, or it can affect the whole body, such as with an allergic reaction.

Sometimes spots or rashes may be present around the area that is itchy, or they may cause the itchiness itself.

It is quite common to find that after you’ve scratched an itch, that the itch becomes more persistent (itchier) and you get into a cycle of itching and scratching. This can be painful and can sometimes lead to an infection if the skin is broken.

If itching persists for more than 48 hours, see your doctor.

How to relieve itching

To relieve itching, take the following steps:

• try not to scratch the area — keep your nails short to prevent breaking the skin if you do scratch
• a cool bath or shower may help to soothe the itching — gently pat yourself dry with a clean towel, but do not rub or use the towel to scratch yourself
• avoid perfumed skin care products
• try to wear loose cotton clothing, which can help prevent you overheating and making the itch worse — avoid fabrics which irritate your skin, like wool or scratchy fabrics
• an ice pack may relieve the itching but should not be placed directly against the skin — you can make an ice pack by using a bag of frozen peas wrapped in a clean cloth
• speak to a pharmacist or your doctor for further advice on treatments that may help, such as calamine lotion, gels or sprays containing aluminium sulphate, a mild corticosteroid cream or antihistamine medicines
• if you are in pain, get advice on suitable pain-relieving medicines from a pharmacist or your doctor

What is anaphylaxis?

Occasionally some people have a severe allergic reaction to being bitten or stung by an insect.

In cases of severe allergic reaction, the whole body can react within minutes to the bite or sting which can lead to anaphylaxis. Anaphylaxis is very serious and can be fatal.

Anaphylaxis symptoms

Symptoms of anaphylaxis include:

• difficult or noisy breathing
• difficulty talking and/or hoarse voice
• a swollen tongue
• persistent dizziness or collapse
• swelling or tightness in the throat
• pale and floppy (young children)
• wheeze or persistent cough
• abdominal pain or vomiting

What should I do if someone has an anaphylactic shock?

Call triple zero (000) for an ambulance. If the person has a 'personal action plan' to manage a known severe allergy, they may need assistance to follow their plan. This may include administering adrenaline to the person via an adrenaline (epinephrine) autoinjector (such as EpiPen or Anapen) if one is available.

The Australasian Society of Clinical Immunology and Allergy recommends that for a severe allergic reaction, adrenaline is the initial treatment. For further information, visit the Choosing Wisely Australia website.

The St John Ambulance Australia first aid fact sheet for bites and stings can be found on their website. For more information on anaphylaxis, including setting up a personal action plan, go to allergy.org.au.

People with diagnosed allergies should avoid all triggers and confirmed allergens and have a readily accessible anaphylaxis action plan and medical alert device. It's wise to ensure your family, friends and employer or work colleagues know how to follow your anaphylaxis action plan too in case you need help.

Watch this video from Allergy & Anaphylaxis Australia for more information about how to recognise signs and symptoms of an allergic reaction.

Video not working? View it here.

How to treat bee, wasp and ant stings

Bee and wasp stings and Australian Jack Jumper ant bites are the most common triggers of anaphylaxis caused by insect stings.

Wasps are generally more aggressive than bees and are attracted to food and sugary drinks. Check open food and drink containers when you are outdoors before you eat or drink from them.

Take these steps if you are stung by a bee:

• if the stinger is still in the skin, gently try to remove it by scraping it carefully from the side with the edge of a firm object, such as a finger nail or credit card — flicking the sting out as soon as possible to reduce the amount of venom injected
• do not use tweezers to remove the sting; bees leave behind a sac of venom, and if you try to use tweezers you will release more venom from the sac
• when you have removed the sting, wash the affected area with soap and water and dry the area gently

Wasps and bull ants rarely leave their sting in the skin.

Always wash the area of the sting with soap and water and keep it clean. Applying a cold pack can help relieve pain and reduce swelling. Simple pain relief medicines such as paracetamol or ibuprofen can also be used if pain continues.

Oral antihistamine medicines or creams containing a mild corticosteroid can help treat itching. Talk to your pharmacist about which treatment is right for you.

If the pain is persistent and continues or if the area of redness where you were stung continues to increase in size, see your doctor. You may need a prescription medicine to help settle the swelling and treat any infection.

How to treat tick bites

Allergic reactions to ticks range from mild (with large local swelling and inflammation at the site of a tick bite) to severe (anaphylaxis).

To prevent allergic reactions to ticks do NOT forcibly remove the tick. Disturbing the tick may cause the tick to inject more allergen-containing saliva. The options are to:

• leave the tick in place and seek medical assistance
• freeze the tick (using a product that rapidly freezes and kills the tick) and allow it to drop off

For more information on tick allergy, visit the Australasian Society of Clinical Immunology and Allergy website.

Ticks can attach to your skin when you’re out and about in the bush.

To protect yourself from ticks, wear light coloured clothing, tuck your trousers into your socks and spray an insect repellent containing diethyltoluamide (DEET) or picaridin onto your skin, shoes and socks.

If you are using a product containing DEET, and you are pregnant or using on children, make sure to follow the instructions for safe usage.

After returning from a tick area, thoroughly check the whole body of all members of the party (especially children) for ticks. Pay particular attention to the back of the head and neck, groin, armpits and back of the knees. You can have more than one tick.

If you are not allergic to ticks, the Australasian Society of Clinical Immunology and Allergy recommend you kill it first with an ether-containing spray. Once dead, the tick should fall off.

If the tick does not drop off, or you can’t freeze the tick, leave the tick in place and seek urgent medical assistance to remove the tick.

If you are allergic to ticks, do NOT forcibly remove the tick. Kill it first with an ether-containing spray and then have it removed by your doctor or go to an emergency department.

Watch this video from the Australasian Society of Clinical Immunology and Allergy (ASCIA) on how to safely remove a tick.

DO NOT:

• grasp the tick by the body,
• apply methylated spirits or fingernail polish
• use a lighted match, or cigarette

Once the tick is out, apply antiseptic cream to the bite site. Tick bites can remain slightly itchy for several weeks.

If the tick isn’t fully removed, you should look out for signs of infection — redness, pain around the wound site, pus or clear liquid coming from the wound, and a high temperature over 38°C.

See your doctor if you develop a reaction around the bite site, or if you feel generally unwell or experience muscle weakness or paralysis after a tick bite.

Learn more about tick bites.

How to treat mosquito bites

Mosquitoes cause itchy bites but severe allergic reactions are rare.

Some types of mosquitoes can spread serious diseases.

See your doctor if you develop a rash, flu-like symptoms such as fever, chills, headaches, joint and muscle pains (swelling or stiffness), fatigue, depression and generally feel unwell.

Most mosquito bites can be managed by washing the area with soap and water and applying an antiseptic. Cold packs may help with local pain and swelling. Talk to your pharmacist or doctor about what treatments are best for you if the bite is very itchy.

To lessen your chance of being bitten by mosquitoes (and midges), cover up as much skin as possible and stay inside in the early morning or at dusk. Use an insect repellent when you are out and about and there are mosquitoes around.

Information on avoiding mosquito bites can be found on the Queensland Health website.

How to treat scorpion and centipede stings

Take these steps if stung by a scorpion or a centipede:

• apply an ice pack to the sting or bite site
• clean the wound with antiseptic or by washing the area with soap and water to help prevent secondary infection
• use a pain-relief medicine such as paracetamol or ibuprofen

How to treat caterpillar stings to the skin

Take these steps if stung by a caterpillar:

• remove visible caterpillar hairs with tweezers
• apply and remove adhesive tape to the area to remove the finer caterpillar hairs
• do not scratch or rub the area, this may cause the hairs to penetrate deeper into the skin

How to treat leech bites

When leeches latch on to skin, their bites are relatively painless; however, their saliva contains an anticoagulant. This stops clots forming when the hosts skin has been broken and allows the leech to feed on their blood.

Applying salt, salt water or vinegar to an actively feeding leech will cause it to fall off, but a leech will usually fall off without any treatment after about 20 minutes or when the leech becomes swollen.

DO NOT:

• try to pull the leech off — the skin may be torn, and this can lead to an infection
• use heat (such as a hot coal or cigarette) as this can result in burns to the person who was bitten

After the leech has been removed:

• wash the area with soap and water
• apply a cold pack to help relieve pain and any swelling
• apply pressure to the site of the bite if it is bleeding
• seek medical attention if a wound develops or the area becomes infected (the skin becomes red, hot or pus develops)

How can I prevent bites and stings?

To help prevent bites and stings, it’s a good idea to wear protective clothing such as closed shoes, socks, long pants and a long sleeved shirt when walking through the bush.

Wear protective gloves and clothing when gardening. Bites and stings can happen when you have bare feet so wear shoes when you are outside, even around your home.

Should I do a first aid course?

Knowing what to do in an emergency can save a life, so it’s a very good idea to do a first aid course.

You can book a first aid course through St John Ambulance Australia’s website or call them at 1300 360 455. You will need to pay a fee to do a course.