Methods of Honey Bee Stinger Removal: A Systematic Review of the Literature

Honey bee envenomations are a common occurrence and cause localized morbidity but rarely cause systemic symptoms or death in humans. Honey bee stingers have a uniquely designed venom sac with a piston-containing bifurcated stinger that can remain in human skin and continue injecting venom after stinging. For some time, it has been proposed that a retained honey bee stinger should be scraped out by a dull edge, as opposed to pinching and pulling out the stinger, in order to minimize the volume of venom injected. We undertook a literature review to evaluate the evidence regarding the effectiveness and safety of methods of honey bee stinger removal. The initial search identified 23 articles of interest; following title and abstract screening, two studies met the inclusion criteria. The included articles used different methods and models to evaluate the relationship between venom injection over time, and one of these studies also compared different methods of stinger removal. The literature review was limited by the small number of studies on the topic, but both included studies include findings relevant to the clinical question of interest. Based on the available evidence, a retained honey bee stinger should be removed as quickly as possible, and there appears to be no disadvantage in doing it by pinching and pulling.