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Common Insect and Marine Bites and Stings: What to do and when to be concerned "Common bites and stings from insects and marine animals can usually be managed readily at home," says Alson Inaba, M.D., FAAP, PALS-NF, Kapi'olani pediatric emergency medicine physician and University of Hawaii associate professor of pediatrics. "Only a small percent will experience an allergic reaction, which requires immediate medical attention," Dr. Inaba adds. When to seek medical care Seek immediate medical care if your child is experiencing: Difficulty breathing Swelling of the lips and tongue Difficulty swallowing or any type of throat discomfort Hives/welts spread over other areas of the body that were not affected by the bite or sting Symptoms of shock, such as chest pain, palpitations, abdominal pain, feeling faint, light-headedness, dizziness Seek medical care if you think that the bite/sting site is getting infected. Stings around the eyes, mouth and neck may require medical attention. Take precautions Patients with previous allergic reactions should always carry the following items: An anaphylaxis emergency treatment kit (Anakit) or an epinephrine autoinjector (Epipen) A medical alert bracelet Treating bites and stings at home Portuguese man-o-war stings Alson Inaba, M.D., FAAP, PALS-NF The majority of man-o-war stings that we see in Hawaii are due to the smaller species, which typically only produce a burning pain and reaction at the site of the sting. The pain typically subsides within an hour without treatment. Anaphylactic reactions (often severe and sometimes fatal allergic reactions) are rare, and there have been no reported deaths due to man-o-war stings in Hawaii. First aid: Carefully remove tentacles and rinse area well with water. Do not rub the area with sand. Although old remedies such as vinegar, urine, meat tenderizer, baking soda and papain have all been used in the past, there are no studies that prove any benefit from these home remedies. Although previous treatments have recommended ice for pain relief, some patients report better results with the application of warm water. Persistent itching may be treated with topical 1-percent hydrocortisone cream or oral Benadryl. Box jellyfish stings Box jellyfish stings are significantly more painful than man-o-war stings, and the pain may last up to eight to 10 hours. A red hive-like welt or lines may last up to a few days. Severe and/or extensive stings may cause chest pain, chills, abdominal pain and vomiting. First aid: To prevent the undischarged stingers from injecting more venom into the skin, immediately flush the area with household vinegar. Do not rub sand on the skin. Although the application of ice has been recommended for pain relief, many patients have found relief by applying warm water. Bee stings Bee stings cause an immediate painful red bump or welt at the site of the sting. There may also be swelling around the affected area. The pain typically subsides after two hours without any treatment. First aid: Remove the stinger as quickly as possible. Pulling the stinger out by pinching the stinger between your fingers may inject more venom into the wound. Therefore, scraping the stinger off may help to minimize the reaction. Application of ice may help to relieve the pain. Although the application of meat tenderizer has been a popular home remedy for pain relief, studies have shown no benefit. Topical 1-percent hydrocortisone cream may provide some relief. Oral Benadryl may ease the itching, swelling and redness. Centipede bites Centipedes typically come out after a heavy rain, after which they are commonly found in the home or even people's shoes. They also can be found under rocks, piles of wood and other hiding places in the yard. Centipede bites are recognizable by two small puncture marks, along with immediate intense pain, which can last for a few hours. There may be redness and swelling around the site for up to 48 hours. Allergic reactions to centipede bites are rare and much less common than allergic reactions to bee stings. First aid: Application of ice may reduce the pain. Oral Benadryl may reduce the swelling and itching. Occasionally, pain may be severe enough to require medical attention. If your child requires immediate medical attention, Kapi'olani's emergency room is open 24 hours a day, with a specially trained pediatric emergency team.