It's normal for people to have "local reactions" to beestings consisting of pain, redness, swelling, and itching.  A local reaction can be quite large in the area of the sting itself.  For instance, with a sting on the hand the local reaction could extend up to the elbow and still be normal, a sting on the foot could extend up to the knee.  Local reactions are a direct effect of the bee venom, and not an allergy.  A history of even very large local reactions does not increase one's risk for allergic reactions at all.

ALLERGIC REACTIONS:

An allergic reaction to a beesting is different.  It's marked by symptoms distant from the sting itself and/or involving vital functions or the whole body.  Hives "all over", or far away from the sting (e.g. sting on the hand, hives on the abdomen) is the mildest and most common allergic reaction.  More serious but less common symptoms of allergic reaction include wheezing, difficulty swallowing, difficulty breathing, throat swelling (or a sensation of throat closing up), total body swelling, cold clammy skin, profuse sweating, confusion, delerium, disorientation, slurred speech, loss of conciousness, low blood pressure, and shock.

WHAT TO DO:

For a local reaction, ice and elevation are all that is necessary.  Benadryl may help itching, but is optional.

If a person has only hives, oral Benadryl is the only treatment necessary.  A history of hives after a beesting, however, unlike a local reaction, DOES increase the odds of a more serious allergic reaction in the future.  It therefore should prompt us to prescribe an EpiPen and refer you to an allergist to consider getting allergy shots for beesting allergy.

If a person shows any of the more serious symptoms of allergic reaction listed above, the EpiPen should be administered if they have one, and 9-1-1 should be called immediately.  Neither EpiPen nor a 9-1-1 call are necessary for hives alone.