Urticarial lesion contiguous with sting site
Severe local reaction may involve one or more neighboring joints
Local reaction occurring in mouth or throat can produce airway obstruction
Local reaction occurring around eye can result in cataract, iris atrophy, globe perforation
Occurs after multiple stings
May be delayed 8-24hrs
Venom mediated, not IgE
Resembles anaphylaxis but greater frequency of nausea/vomiting and diarrhea
Other symptoms: light-headedness, syncope, headache, fever, drowsiness, muscle spasms
Massive stings can result in renal or hepatic failure, DIC, rhabdo
Systemic toxicity more likely if > 50 stings
Median lethal dose of honeybee venom ~19 stings/kg or 500-1400 stings per human
Other symptoms: light-headedness, syncope, headache, fever, drowsiness, muscle spasms
Majority occur within first 15min; nearly all within 6hr
No correlation with number of stings
IgE mediated, rather than direct response to the venom.
Shorter the interval between sting and onset of symptoms the more severe the reaction
May occur 5-14d after a sting
Serum sickness features (fever, malaise, urticaria, lymphadenopathy, polyarthritis)
Hymenoptera stings
Hymenoptera stings 
Sea wasp sting
Mammalian bites
Lizard bites
Closed fist infection 
Caustic cocktail
Dog bite