Denkler Keith A, Hudson Rosalind F
Division of Plastic Surgery, University of California, San Francisco, California, USA.
Private Practice Internal Medicine, Larkspur, California, USA.
J Am Coll Emerg Physicians Open. 2025 Jan 8;6(1):100009. doi: 10.1016/j.acepjo.2024.100009. eCollection 2025 Feb.
Bee stings are very common worldwide. About 5% to 15% of those afflicted have a large local reaction, defined as a skin reaction around the sting site with edema, erythema, itching, and an injury diameter >10 cm. Standard treatments for large local reactions include ice, nonsteroidal anti-inflammatory medications, antihistamine medications, and topical or systemic corticosteroids, none of which immediately treat the pain associated with the symptoms nor initiate immediate treatment of the allergic and inflammatory response. We present a dramatic and rapid reversal of a periorbital large local reaction treated with subcutaneous and intradermal injection of 1% lidocaine with epinephrine into the sting area. The lidocaine rapidly reversed the symptoms of pain and pressure, and the low dose of epinephrine, within 2 hours, significantly reversed the allergic periorbital and eyelid edema. No further symptoms evolved, suggesting that the epinephrine terminated the allergic cascade.
蜜蜂蜇伤在全球范围内非常常见。约5%至15%的受害者会出现严重的局部反应，定义为蜇伤部位周围的皮肤反应，伴有水肿、红斑、瘙痒，且损伤直径>10厘米。严重局部反应的标准治疗方法包括冰敷、非甾体类抗炎药物、抗组胺药物以及局部或全身性皮质类固醇，但这些方法都不能立即缓解与症状相关的疼痛，也不能立即启动对过敏和炎症反应的治疗。我们展示了通过在蜇伤区域皮下和皮内注射1%利多卡因加肾上腺素，戏剧性且迅速地逆转了眶周严重局部反应。利多卡因迅速缓解了疼痛和压迫症状，低剂量的肾上腺素在2小时内显著逆转了眶周和眼睑的过敏性水肿。没有进一步的症状出现，这表明肾上腺素终止了过敏反应级联。
