Insect bites and stings are common but irritating parts of life, especially during the warmer months. Most bites and stings cause mild symptoms and disappear within a few days. However, some require medical attention and can even be life-threatening.
Thousands of people go to the emergency room each year for insect stings, and about 100 die each year from fatal reactions to bites and stings. Particularly, in the Dominican Republic the highest incidence of mosquito bites occurs between May and November, coinciding with the rainy season.
“Most bites are mild and can be treated at home,” says Vania Tareco, DO, emergency medicine doctor at Mass General Brigham Urgent Care. “However, they can become serious if an allergic reaction or infection develops.” She offers several tips to help you determine when to see a doctor for an insect bite.
When to go to the emergency room for an insect bite
Allergy to mosquito bites is a global public health problem according to the World Health Organization (WHO), with an estimated prevalence of between 10% and 20% of the population. It is estimated that more than 3 million people in Latin America and the Caribbean experience allergic reactions to mosquito bites each year.
Dr. Tareco recommends that you go to the emergency room immediately if you experience any signs of a severe allergic reaction or infection.
Symptoms of an allergic reaction to an insect bite
Signs and symptoms of an allergic reaction include:
Greater than expected reaction in some part of the body (for example, your ankle itches, but your entire leg swells).
“If you have symptoms of an allergic reaction, you should seek in-person emergency care immediately,” says Dr. Tareco. “Go to the nearest emergency room or call 911, depending on the severity of the symptoms.” The emergency department may give you antihistamines, corticosteroids, epinephrine (adrenaline), or other interventions to help you breathe.
Even if you have used a device that self-injects epinephrine (an EpiPen®), you should seek medical attention, says Dr. Tareco. “During an allergic reaction, an EpiPen can make you feel better quickly, but you risk a relapse of symptoms,” she explains. «In severe reactions, patients may need additional doses of epinephrine and other medications. “A delay in care could put you at higher risk of complications.”
Signs of an infected insect bite
If you scratch the skin where you have a sting or bite, you can create an opening for bacteria to enter. The infection usually appears a couple of days after the initial sting or bite, and signs include:
- Fever
- Pus
- Red streaks on the skin extending from the bite area
- Worsening redness, pain, or warmth around the bite area.
Another possible infection related to insect bites is ticks and Lyme’s desease. Dr. Tareco advises seeking medical attention if she notices a tick or bite and if:
- A bull’s-eye rash appears (although not everyone with Lyme disease develops this rash).
- He has fever, headacheneck pain or flu symptoms.
- You experience widespread joint pain in the days or months after the bite.
- The area is very swollen
- You think you have had a tick for 36 hours or more.
«It is very important to start taking antibiotics as soon as possible if the bite is infected. And if you have been bitten by a tick, you should talk to your doctor about whether you should be tested for Lyme disease or receive prophylactic (preventive) treatment.”
If you notice any of these signs or symptoms, call your GP (PCP). Your doctor’s office can recommend next steps and help you with any urgent problems. Many Mass General Brigham primary care offices for adults and children offer same-day, in-person visits and virtual.
When should you go to the emergency room for insect bites?
People with insect bites and stings often do not need the high level of acute care provided in the emergency room. However, you may still want to see a doctor. If you don’t have a primary care doctor or there are no appointments available, you can go to an urgent care center.
Another useful option is Mass General Brigham Virtual Urgent Care. It is open to all patients ages 3 and older, even if they have not seen a Mass General Brigham provider before. Both new and existing patients can schedule a virtual urgent care visit for that day or the next day at Mass General Brigham Patient Gateway.
During a virtual urgent care visit, you can upload photos of the insect sting or bite. The health team asks you several questions, such as if you know what bit you, when the bite occurred, and what symptoms you have. They quickly determine if you need immediate in-person care.
“We’ll make sure you’re okay, screen you for allergic and infectious symptoms, and make sure you’re comfortable and stable,” says Dr. Tareco. “If there is any cause for concern – for example, if we need to check your vital signs or give you immediate medication – we will tell you exactly where to go for urgent care.”
If you do not need urgent 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
- Tell you what to look for and when to seek additional medical care.
Treat an insect bite at home
If an insect bite irritates you mildly but does not cause serious symptoms, you can usually treat it at home. Dr. Tareco recommends several strategies.
“First, remove any stingers, ticks, or insect fragments from your skin. “An over-the-counter tick tool can be helpful for removing them,” she says. «If you see remains of a possible foreign body, it must be removed 100%. Then, you have to clean the skin area and disinfect it properly.
Gently wash the area with soap and water. (Hydrogen peroxide and alcohol can also be used.) Apply a damp cloth, cold water, or an ice pack to the area for 10 to 20 minutes to relieve symptoms.
He also comments that “Calamine lotion, 0.5% to 1% hydrocortisone cream, or a paste made with baking soda mixed with a little water can reduce pain, swelling, and redness. “Over-the-counter antihistamines, such as diphenhydramine cream, Claritin®, and Allegra®, may also be helpful.”
Prevention of insect bites
The Ministry of Public Health of the Dominican Republic reports that mosquito-borne diseases such as dengue, chikungunya and malaria continue to be a significant public health problem in the country.
Until epidemiological week number 18 on May 5, 2024, 13,542 cases of dengue, 1,874 cases of chikungunya and 312 cases of malaria were reported, the most affected regions being the Metropolitan, Enriquillo and Cibao Norte, and the highest risk groups are children under 15 years of age, pregnant women and people with chronic diseases.
The best treatment is to avoid insect bites in the first place. For this, Dr. Tareco recommends taking the following precautions:
- Apply insect repellent on skin and clothing when outdoors. Do not apply sweet-smelling products such as perfumes, lotions, and deodorants.
- Avoid areas with standing water and always cover trash cans, as they can attract insects.
- Avoid going out at dawn and dusksince this is when mosquitoes and other insects are most active.
- Dress appropriately when outdoors. Consider wearing long sleeves, pants, and closed-toe shoes when doing activities like hiking or gardening.
- Keep windows and mosquito nets in good conditionto prevent insects from entering the house.
- Keep food and drinks covered when eating or drinking outdoors. Insects are often attracted to these objects.
