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Sirithanan Charoenwikkai,1,2 Premmika Intapun,1 Mongkol Lao-Araya1 1Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand; 2Khanu Woralaksaburi Hospital, Saen To, Khanu Woralaksaburi, Kamphaeng Phet, 62130, ThailandCorrespondence: Mongkol Lao-Araya, Division of Allergy and Clinical Immunology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand, Tel +665 393 5412-15, Fax +665 393 5412, Email laoaraya@gmail.comObjective: This study aims to assess the clinical outcomes and risk factors associated with severe systemic reactions following bee stings, focusing on patients treated at Pa-Sang Community Hospital, located in Lamphun Province, Thailand, which is recognized as one of the country’s largest apicultural areas.Methods: A retrospective review was conducted, utilizing electronic medical records with ICD-10 coding, of patients treated for bee sting injuries at the Emergency Department of Pa-Sang Hospital from January 2015 to December 2019.Results: This analysis included a total of 591 bee sting events involving 533 patients. The average incidence of bee sting injuries was 31.3 per 10,000 Emergency Department visits, with 55% being male. A significant majority (86%) of events occurred outside the patients’ home area. Notably, the head or extremities (49%) were the most common anatomical sites stung. Systemic reactions were observed in 44% of cases, with 96 visits (16%) diagnosed as anaphylaxis. Epinephrine injection was administered in 77% of these cases, and fortunately, no fatal anaphylactic reactions were recorded. Protective factors for anaphylaxis and severe systemic reactions after bee stings included age less than 15 years old and stings on extremities. Conversely, having more than ten bee stings and seeking Emergency Department treatment within 60 minutes of being stung were identified as significant risk factors.Conclusion: Bee sting injuries were a common presentation at the hospital situated in the high apicultural area, and severe systemic reactions were observed. This study highlights the need for comprehensive interventions to mitigate the increased risk of bee-related accidents in communities with thriving apicultural industries.Keywords: bee sting, venom, anaphylaxis, bee keeping, Thailand