Disclaimer: This article is NOT meant as medical advice. It is solely for the purpose of helping writers write about medicine, and is not a substitute for medical care or advice. Please don’t sue me.
Great question! Luckily for you, the answer is pretty much that you get to decide. People with a mild allergy might get nothing more than redness and swelling around the site of the sting. A moderate reaction – called a large local reaction (LLR) – would result in swelling, itchiness, and redness that extends beyond the site of the sting. For example, if your character was stung on the finger, their whole hand might swell up, and they might not be able to remove their rings. And while this reaction might look intimidating, it is not life-threatening. The third and most severe reaction is anaphylaxis.
Anaphylaxis is the most serious form of allergy – a whole-body reaction that occurs seconds to minutes after exposure. It usually starts with skin symptoms – a rash or hives – but can quickly progress to breathing problems, dangerously low blood pressure, and sometimes abdominal symptoms, such as nausea and vomiting. Severe anaphylaxis can lead to asphyxiation and death.
Signs of Anaphylaxis
- Swollen face, especially noticeable around the lips and eyes
- Tongue and throat swelling
- Trouble breathing
- Fast heart rate
- Hives (red, raised, itchy rash)
- Nausea/vomiting à especially in food allergies
- Weak, thready pulse (anaphylactic shock)
It’s important to note that there are levels of severity of anaphylactic reactions as well. If there are hives all over your character’s body, it is still an anaphylactic reaction, even if their airway isn’t affected. Your character might only notice a slight swelling in their lips or eyes, or they might feel their airway closing off, but would still have plenty of time to call an ambulance or have someone drive them to the hospital for treatment. However, in a severe anaphylactic reaction, the airway can swell shut in minutes. If untreated, your character could die of asphyxiation in as little as 15 minutes
Don’t let your character drive themselves to the hospital unless you want to add a car crash to their list of injuries.
If your character’s last reaction to a bee sting was hives only, it would still be realistic for this reaction to include airway swelling. Allergies can worsen with subsequent exposures. On the other hand, if your character is elderly, they may have less of a reaction than they did when they were a child. Allergies evolve over time, and your character’s allergies can improve or worsen depending on the needs of your story.
Let’s finish up by talking about treatment of anaphylaxis.
Treatment of Anaphylaxis
The immediate treatment of anaphylaxis is with epinephrine. People who know they are at risk of an anaphylactic reaction are supposed to carry an EpiPen – an autoinjector filled with epinephrine that looks a bit like a chubby yellow glue stick – with them at all times. But realistically, that doesn’t always happen. EpiPens are expensive, they can expire, and–though small and portable–are too big to fit in most wallets. It is all too easy for your character to leave their EpiPen sitting forgotten in an unused purse or drawer, especially if their last anaphylactic reaction was just hives. But for someone with a serious anaphylactic reaction, not having an EpiPen available could be the difference between life and death.
The cost of epi-pens rose over 400% between 2007 and 2016, and now can cost over $500. Why? Because the manufacturer had a monopoly and they could.
Epinephrine has lots of side effects – it constricts the blood vessels and makes the heart beat faster and stronger. It can cause a heart attack, so if your character uses their epi-pen, they’re still going to need a trip to the hospital, even if they’re feeling better.
The Takeaway
It’s up to you! Since people with bee allergies (all allergies, really) can exhibit a wide range of reactions, you can choose the severity that works for you.