Bee Stings
By Peter N. Landless and Allan R. Handysides
My granddaughter was stung by a wasp or a bee—I’m not sure which—and she had a nasty reaction. Her hand swelled, and she had quite a lot of redness. Do you think she’s at risk for anaphylaxis?
Insect bites or stings can cause variably severe reactions, but the group of insects called Hymenoptera is the more serious one. Three families of Hymenoptera commonly cause allergic reactions: These are the Apidae (honeybees and bumblebees), Vespidae (wasps, hornets, and yellow jackets), and Formicidae (fire ants).
Only female Hymenoptera sting, and usually only as a defense mechanism when threatened. The venom contains several amines and kinins, chemicals that mediate and help us to feel the pain, swelling, and itching at the site of the sting.
Honeybees leave the stinger in the victim, but although it can be removed by scraping with a fingernail, removal doesn’t lessen the reaction. This is because the venom is usually discharged within 20 to 30 seconds, or by the time the stinger is removed. The presence of a strong local reaction doesn’t mean there will be a bodywide (systemic) reaction, the severest of which is known as anaphylaxis. Once a person has had a systemic reaction with a strong allergic manifestation, however, one can anticipate and be ready for a major reaction with subsequent stings. Such reactions are usually very rapid, although on occasion they may be delayed.
Anyone who has had a serious reaction should be referred to an allergist/immunologist and tested for venom-specific IgE antibodies. These antibodies are specifically related to allergic reactions of varying degrees. Patients should be considered for desensitization, which may require some three years of repeated exposure to the specific antigen to accomplish the treatment successfully.
The incidence of death as a result of bee stings varies around the world, with as few as two per year in Sweden to about 40 in the United States. Honeybees belong to the Hymenoptera order of insects and are by far the most common culprits.
The so-called killer bees are not more venomous but rather more aggressive, attacking sometimes in swarms. If this happens, a toxic (poisonous)—as opposed to allergic—reaction may occur.
Usually the transient local reaction requires little treatment other than cold compresses, ice, or some topical/local anesthetic and corticosteroid cream. Antibiotics are seldom required, and the appearance of red streaking early on indicates a venom reaction rather than an infection.
Systemic reactions are much more serious and require prompt medical attention. Upper-airway obstruction and/or cardiovascular collapse can be life-threatening. The immediate injection of epinephrine (adrenaline) into the mid-thigh muscle should be done with a preloaded EpiPen, or a dose of 0.5 milligrams for an adult and 0.3 milligrams for a child. There is no contraindication to the use of adrenaline/epinephrine; in the presence of anaphylaxis, it’s a lifesaver.
If symptoms persist, a repeat dosage at intervals of five to 15 minutes is indicated. Most patients will require only one injection, but rapid transport to medical attention is imperative. Antihistamines also help fend off symptoms. It’s important that at least 12 hours of observation in a unit equipped to handle recurrence of symptoms be provided.
Both adults and children with a history of anaphylaxis should carry an auto-injector of epinephrine. Care to avoid at-risk areas is very important for such patients, and it may be wise to have more than one auto-injector available at all times.
The take-home message is that the difference between a local reaction (pain, swelling, redness around the area of the sting) and a systemic reaction (swelling of tissues in the throat, respiratory difficulty, or collapse) must be clearly recognized, as systemic reactions are the dangerous ones. n
Peter N. Landless, a board-certified nuclear cardiologist, is director of the General Conference Health Ministries Department.
Allan R. Handysides, a board-certified gynecologist, is a former director of the General Conference Health Ministries Department.
