A bee sting is followed by wheal development, flushing, hives, rhinorrhea, and chest tightness. Immediate therapy should be to

• A. Transfer him to a local hospital emergency department.
• B. Apply a cold compress to the sting site.
• C. Administer subcutaneous epinephrine.
• D. Administer oral albuterol

Answer: (C)

This scenario shows systemic anaphylaxis from a bee sting, suggested by widespread wheal and flare, flushing, hives, rhinorrhea, and chest tightness indicating bronchospasm. The immediate therapy is epinephrine because it rapidly counteracts the life-threatening components of anaphylaxis: it causes vasoconstriction to reduce swelling and improve blood pressure, and it relaxes bronchial smooth muscle to relieve airway constriction, while also supporting cardiac output. Administering epinephrine as soon as anaphylaxis is suspected is the most important step to prevent progression to shock or respiratory failure.

The preferred route is intramuscular injection into the mid-thigh for fastest, most reliable absorption; some older guidance mentions subcutaneous as an option, but intramuscular administration is favored when available. After giving epinephrine, call emergency services, monitor the patient, and be prepared to repeat dosing if symptoms recur or persist, as directed by guidelines. Additional measures like oxygen and airway support may be needed, but epinephrine is the first and most crucial intervention.