Bug bites and stings are a common but irritating part of life, especially during warmer months. The vast majority of bites and stings cause mild symptoms and go away within a few days. But some require medical attention and may even be life-threatening.
Thousands of people visit emergency rooms and urgent care centers for insect bites every year — and about 100 people die per year from fatal reactions to bites and stings.
“Most bites are mild and can be treated at home,” says Vania Tareco, DO, an emergency medicine doctor at Mass General Brigham Urgent Care. “However, they can become serious if you develop an allergic reaction or an infection.” She offers several tips to help you determine when to see a doctor for a bug bite.
Dr. Tareco recommends you seek immediate emergency care if you’re experiencing any signs of a severe allergic reaction or infection.
Signs and symptoms of an allergic reaction include:
Hives or a rash (often itchy) on other areas of your body, not just where you were bitten or stung
Swelling of your lips, tongue, or throat
Trouble swallowing, breathing, or talking
Abdominal cramping, nausea, vomiting, or diarrhea
Loss of consciousness, dizziness, lightheadedness, or confusion
“If you have symptoms of an allergic reaction, you should seek in-person emergency care right away,” Dr. Tareco says. “Go to the nearest emergency room or call 911, depending on the severity of your symptoms.” The emergency department can provide antihistamines, corticosteroids, epinephrine (adrenaline), or other interventions to help you breathe.
Even if you have used a device that auto-injects epinephrine (an EpiPen®), you should still seek medical care, Dr. Tareco says. “During an allergic reaction, an EpiPen can often make you quickly feel better, but you are at risk for a relapse in symptoms,” she explains. “In severe reactions, patients may need additional doses of epinephrine and other medications. A delay in care can place you at a higher risk of complications.”
If you scratch the skin where you have a bite or sting, you can create an opening for bacteria to enter. Infection generally develops a couple of days after the initial bite or sting, and signs include:
Red streaks on the skin extending away from the bite area
Worsening redness, pain, or warmth around the bite or sting area
Another potential infection related to insect bites involves ticks and Lyme disease. Dr. Tareco says you should seek medical attention if you notice a tick or a bite and:
Develop a bulls-eye rash that looks like a target (though not all people with Lyme disease get the rash)
Experience widespread joint pain in the days to months after the bite
The area is significantly swollen
Think a tick may have been on you for 36 hours or more
“It’s very important to start antibiotics as soon as possible if a bug bite is infected. And if you’ve had a tick bite, you should talk with your doctor about whether you should be screened for Lyme disease or receive prophylactic (preventative) treatment.”
If you notice any of these signs or symptoms, call your primary care provider (PCP). Your doctor's office can recommend next steps and assist with any urgent issues. Many Mass General Brigham primary care practices for adults and children offer same-day, in-person, and virtual visits.
People with bug bites and stings often don’t need the high level of acute care provided in the emergency room. But you may still want to see a doctor. If you don’t have a PCP or no appointments are available, you can go to an urgent care location.
Another helpful option is Mass General Brigham Virtual Urgent Care. It’s open to all patients ages 3 and up, even if they haven’t seen a Mass General Brigham provider before. Patients may use both on-demand and scheduled appointments. Patients who are new to Mass General Brigham may access on-demand care without an appointment. Existing patients may access the Virtual Urgent Care On Demand option, or schedule a visit through the Patient Gateway Platform. This integration ensures continuity of care with your existing care team.
During a virtual urgent care visit, you can upload photos of the bug bite or sting. The health care team asks you several questions, such as whether you know what bit you, when the bite or sting occurred, and what symptoms you have. They quickly determine whether you need immediate in-person care.
“We’ll make sure you’re feeling well, screen you for concerning allergic and infection symptoms, and make sure you feel comfortable and stable,” Dr. Tareco says. “If there is any concern — for example, we need to check your vital signs or give you immediate medications — we’ll tell you exactly where to go for emergency care.”
If you don’t require emergency care, the team can:
Make a diagnosis
Recommend strategies to relieve symptoms at home
Prescribe medications or recommend over-the-counter medications to relieve symptoms and prevent infection
Educate you about what to look for and when to seek additional medical care
If a bug bite or sting is mildly irritating but you don’t have any serious symptoms, you can generally treat it at home. Dr. Tareco recommends several strategies.
“First, remove stingers, ticks, or insect fragments from your skin. An over-the-counter tick tool might be helpful with removal,” she says. “If you see any remnants of a possible foreign body, the foreign body needs to be 100% removed. Then the area of your skin needs to be cleaned and properly disinfected.”
Gently wash the area with soap and water. (Hydrogen peroxide and alcohol can be used as well.) Apply a damp cloth, cold water, or an ice pack to the area for 10 to 20 minutes to relieve symptoms.
“Calamine lotion, 0.5% to 1% hydrocortisone cream, or a paste made from baking soda mixed with a little bit of water can reduce pain, swelling, and redness. Over-the-counter antihistamines may also be helpful, such as diphenhydramine cream, Claritin®, and Allegra®,” she says.
The best treatment is to avoid bug bites in the first place. Dr. Tareco recommends that people take the following precautions:
Apply bug repellent to your skin and clothes when you are outside. Don’t apply sweet-smelling products such as perfume, lotion, and deodorant.
Avoid areas of standing water and always cover trash bins, as both can attract insects.
Avoid going outside at dawn and dusk, when mosquitoes and other bugs are most active.
Dress appropriately when you’re outdoors. Consider wearing long sleeves, pants, and closed shoes during activities such as hiking or gardening.
Keep windows and screens functional, which can stop bugs from coming inside your house.
Keep foods and beverages covered when eating or drinking outdoors. Bugs are often attracted to these items.