Anaphylaxis Following Multiple Bee Stings in a Rural Primary Health Centre: A Case Report and Literature Review

Anaphylaxis Following Multiple Bee Stings in a Rural Primary Health Centre: A Case Report and Literature Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Anaphylaxis Following Multiple Bee Stings in a Rural Primary Health Centre: A Case Report and Literature Review Dr.SMIT SONI This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7342086/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: Hymenoptera stings can cause severe allergic reactions, including life-threatening anaphylaxis. Rapid recognition and treatment are essential, especially in rural settings with limited resources. Case Presentation: A 33-year-old male farmer presented to a rural PHC 30 minutes after multiple bee stings to the face, neck, arms, and trunk. On arrival, he had BP 100/60 mmHg, pulse 110 bpm, SpO₂ 90%, mild dyspnea, and facial swelling. Immediate intramuscular adrenaline, oxygen therapy, intravenous fluids, and adjunctive medications were administered. The patient was stabilized and referred to a tertiary hospital for observation. Conclusion: Early administration of intramuscular adrenaline remains the cornerstone of anaphylaxis management. This case highlights the importance of preparedness and training at the primary care level in rural areas. 1. Introduction Bee stings are a common cause of outdoor anaphylaxis worldwide, particularly in rural and agricultural communities. Anaphylaxis is a severe, potentially fatal, systemic hypersensitivity reaction characterized by rapid onset and involvement of multiple organ systems. Without prompt recognition and treatment, anaphylaxis can progress rapidly to airway compromise, shock, and death. This report describes a case of anaphylaxis following multiple bee stings managed in a rural primary health centre (PHC), followed by a literature review focusing on pathophysiology, emergency management, and rural healthcare challenges. 2. Case Presentation A 33-year-old male farmer presented to a PHC approximately 30 minutes after being attacked by a swarm of bees while working outdoors. He sustained an estimated 25–30 stings over his face, neck, arms, and trunk. On arrival: - Vital signs: BP 100/60 mmHg, HR 110 bpm, RR 26/min, SpO₂ 90% on room air. - Symptoms: Generalized pruritus, facial swelling, mild difficulty breathing, dizziness. - Examination: Multiple erythematous swellings with visible stingers, mild facial edema, bilateral wheeze, no tongue or airway swelling at presentation. Management: 1. Airway & Breathing: High-flow oxygen via non-rebreather mask. 2. Circulation: Immediate intramuscular adrenaline 0.5 mg (1:1000) in the mid-outer thigh; IV line secured, 500 mL isotonic crystalloid bolus given. 3. Adjunctive therapy: IV chlorpheniramine 10 mg, IV hydrocortisone 200 mg. 4. Local measures: Stinger removal via gentle scraping. 5. Monitoring: Continuous SpO₂, BP, and HR monitoring. 6. Referral: Stabilized and transferred to tertiary centre for observation and further management. The patient recovered without complications after 24 hours of monitoring. 3. Discussion Hymenoptera venom contains melittin, phospholipase A₂, and hyaluronidase, which trigger both direct toxic effects and immune-mediated reactions. Allergic anaphylaxis is mediated by IgE and leads to histamine release, causing vasodilation, increased vascular permeability, bronchospasm, and hypotension. Key management points: - Anaphylaxis is a clinical diagnosis; do not delay treatment for investigations. - Adrenaline IM is the first-line therapy — delays increase morbidity and mortality. - Oxygen and rapid IV fluids are critical for circulatory support. - Antihistamines and corticosteroids are adjuncts; they do not replace adrenaline. - In rural settings, training healthcare workers to recognize and treat anaphylaxis promptly is crucial, given limited diagnostic facilities. 4. Conclusion This case highlights the importance of early recognition and treatment of anaphylaxis in rural healthcare settings. Stocking adrenaline, maintaining basic airway equipment, and training PHC staff are essential steps in preventing mortality from severe allergic reactions. Declarations Consent Written informed consent was obtained from the patient for publication of this case report and any accompanying images. Conflicts of Interest The authors declare no conflicts of interest. References Simons FE, et al. World Allergy Organization Guidelines for the assessment and management of anaphylaxis. World Allergy Organ J. 2011;4(2):13-37. Soar J, et al. Emergency treatment of anaphylactic reactions: Guidelines. Resuscitation. 2021;163:86-96. Krishna MT, et al. Diagnosis and management of hymenoptera venom allergy: British Society for Allergy and Clinical Immunology guideline. Clin Exp Allergy. 2011;41(9):1201-1220. Oxford Handbook of Clinical Medicine, 11th Edition. Oxford University Press; 2023. Golden DBK, et al. Stinging insect hypersensitivity: A practice parameter update 2016. Ann Allergy Asthma Immunol. 2017;118(1):28-54. Pucci S, et al. Multiple bee stings and systemic reactions: A case series. J Emerg Med. 2014;46(5):e127-e131. Govindarajan R, et al. Challenges in emergency care in rural India. Indian J Community Med. 2012;37(1):19-23. Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7342086","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":498481630,"identity":"14cfc73e-4165-4cad-b888-880aaa1c8b25","order_by":0,"name":"Dr.SMIT SONI","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA60lEQVRIiWNgGAWjYFACxgYQycPG3v/xAYjBR4SWRpAeHn6eA8YGYL1EWyM5w8FMAsQgqEV+2uH2hz8q7sgY3GBIq/yaYyfDxsD88NENPFoMbic2NvOcecZjcLvh2G3ZbclAh7EZG+fg0yIN1MLYdpjH4M7BttuS25iBWnjYpPFpkZ+d2Nj4E6TlRjJbseS2esJaGIAOa+AFapGckcbG+HHbYcJaQH6ZzXPmMDCQzzBLM247zsPGTMAv8rPTH3z8UXHYno29h/Hjz23V9vzszQ8f43UYMmDmAZPEKgcBxh+kqB4Fo2AUjIIRAwCgeEjjS9v2vwAAAABJRU5ErkJggg==","orcid":"","institution":"","correspondingAuthor":true,"prefix":"Dr.","firstName":"SMIT","middleName":"","lastName":"SONI","suffix":""}],"badges":[],"createdAt":"2025-08-11 04:04:37","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-7342086/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7342086/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88855378,"identity":"6fc34cd0-6a54-494a-88ac-04e46a50ae2a","added_by":"auto","created_at":"2025-08-12 06:27:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":196000,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7342086/v1/8b7dbd24-3766-4dc5-b5d7-5595abcbf6c8.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eAnaphylaxis Following Multiple Bee Stings in a Rural Primary Health Centre: A Case Report and Literature Review\u003c/p\u003e","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eBee stings are a common cause of outdoor anaphylaxis worldwide, particularly in rural and agricultural communities. Anaphylaxis is a severe, potentially fatal, systemic hypersensitivity reaction characterized by rapid onset and involvement of multiple organ systems. Without prompt recognition and treatment, anaphylaxis can progress rapidly to airway compromise, shock, and death. This report describes a case of anaphylaxis following multiple bee stings managed in a rural primary health centre (PHC), followed by a literature review focusing on pathophysiology, emergency management, and rural healthcare challenges.\u003c/p\u003e"},{"header":"2. Case Presentation","content":"\u003cp\u003eA 33-year-old male farmer presented to a PHC approximately 30 minutes after being attacked by a swarm of bees while working outdoors. He sustained an estimated 25\u0026ndash;30 stings over his face, neck, arms, and trunk.\u003c/p\u003e\n\u003cp\u003eOn arrival:\u003c/p\u003e\n\u003cp\u003e- Vital signs: BP 100/60 mmHg, HR 110 bpm, RR 26/min, SpO₂ 90% on room air.\u003c/p\u003e\n\u003cp\u003e- Symptoms: Generalized pruritus, facial swelling, mild difficulty breathing, dizziness.\u003c/p\u003e\n\u003cp\u003e- Examination: Multiple erythematous swellings with visible stingers, mild facial edema, bilateral wheeze, no tongue or airway swelling at presentation.\u003c/p\u003e\n\u003cp\u003eManagement:\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003e1. Airway \u0026amp; Breathing: High-flow oxygen via non-rebreather mask.\u003cbr\u003e\u003c/span\u003e\u003cspan\u003e2. Circulation: Immediate intramuscular adrenaline 0.5 mg (1:1000) in the mid-outer thigh; IV line secured, 500 mL isotonic crystalloid bolus given.\u003cbr\u003e\u003c/span\u003e\u003cspan\u003e3. Adjunctive therapy: IV chlorpheniramine 10 mg, IV hydrocortisone 200 mg.\u003cbr\u003e\u003c/span\u003e\u003cspan\u003e4. Local measures: Stinger removal via gentle scraping.\u003cbr\u003e\u003c/span\u003e\u003cspan\u003e5. Monitoring: Continuous SpO₂, BP, and HR monitoring.\u003cbr\u003e\u003c/span\u003e\u003cspan\u003e6. Referral: Stabilized and transferred to tertiary centre for observation and further management.\u003cbr\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eThe patient recovered without complications after 24 hours of monitoring.\u003c/p\u003e"},{"header":"3. Discussion","content":"\u003cp\u003eHymenoptera venom contains melittin, phospholipase A₂, and hyaluronidase, which trigger both direct toxic effects and immune-mediated reactions. Allergic anaphylaxis is mediated by IgE and leads to histamine release, causing vasodilation, increased vascular permeability, bronchospasm, and hypotension.\u003c/p\u003e\n\u003cp\u003eKey management points:\u003c/p\u003e\n\u003cp\u003e- Anaphylaxis is a clinical diagnosis; do not delay treatment for investigations.\u003c/p\u003e\n\u003cp\u003e- Adrenaline IM is the first-line therapy \u0026mdash; delays increase morbidity and mortality.\u003c/p\u003e\n\u003cp\u003e- Oxygen and rapid IV fluids are critical for circulatory support.\u003c/p\u003e\n\u003cp\u003e- Antihistamines and corticosteroids are adjuncts; they do not replace adrenaline.\u003c/p\u003e\n\u003cp\u003e- In rural settings, training healthcare workers to recognize and treat anaphylaxis promptly is crucial, given limited diagnostic facilities.\u003c/p\u003e"},{"header":"4. Conclusion","content":"\u003cp\u003eThis case highlights the importance of early recognition and treatment of anaphylaxis in rural healthcare settings. Stocking adrenaline, maintaining basic airway equipment, and training PHC staff are essential steps in preventing mortality from severe allergic reactions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eConsent\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient for publication of this case report and any accompanying images.\u003c/p\u003e\n\u003cp\u003eConflicts of Interest\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSimons FE, et al. World Allergy Organization Guidelines for the assessment and management of anaphylaxis. World Allergy Organ J. 2011;4(2):13-37.\u003c/li\u003e\n\u003cli\u003eSoar J, et al. Emergency treatment of anaphylactic reactions: Guidelines. Resuscitation. 2021;163:86-96.\u003c/li\u003e\n\u003cli\u003eKrishna MT, et al. Diagnosis and management of hymenoptera venom allergy: British Society for Allergy and Clinical Immunology guideline. Clin Exp Allergy. 2011;41(9):1201-1220.\u003c/li\u003e\n\u003cli\u003eOxford Handbook of Clinical Medicine, 11th Edition. Oxford University Press; 2023.\u003c/li\u003e\n\u003cli\u003eGolden DBK, et al. Stinging insect hypersensitivity: A practice parameter update 2016. Ann Allergy Asthma Immunol. 2017;118(1):28-54.\u003c/li\u003e\n\u003cli\u003ePucci S, et al. Multiple bee stings and systemic reactions: A case series. J Emerg Med. 2014;46(5):e127-e131.\u003c/li\u003e\n\u003cli\u003eGovindarajan R, et al. Challenges in emergency care in rural India. Indian J Community Med. 2012;37(1):19-23.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"GMERS MEDICAL COLLEGE, GANDHINAGAR ","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7342086/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7342086/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIntroduction: Hymenoptera stings can cause severe allergic reactions, including life-threatening anaphylaxis. Rapid recognition and treatment are essential, especially in rural settings with limited resources.\u003c/p\u003e\u003cp\u003eCase Presentation: A 33-year-old male farmer presented to a rural PHC 30 minutes after multiple bee stings to the face, neck, arms, and trunk. On arrival, he had BP 100/60 mmHg, pulse 110 bpm, SpO₂ 90%, mild dyspnea, and facial swelling. Immediate intramuscular adrenaline, oxygen therapy, intravenous fluids, and adjunctive medications were administered. The patient was stabilized and referred to a tertiary hospital for observation.\u003c/p\u003e\u003cp\u003eConclusion: Early administration of intramuscular adrenaline remains the cornerstone of anaphylaxis management. 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