Taking the Sting Out of Insect Allergies -- David B.K. Golden, MD -- 7/15/03
By David Golden
Bees, wasps, and hornets can quickly take the fun out of summer activities, especially if an allergy makes an insect encounter a potentially life-threatening event. It's best to "bee" prepared for whatever buzzes your way. Insect allergy expert David B.K. Golden, MD, was our guest.
The opinions expressed in this transcript are those of the guest and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.
Moderator: When we talk about stinging insects -- exactly what critters are we talking about?
Golden: That's a very good starting point. Stinging insects are all in the same large family. They include honeybees, yellow jackets, hornets, wasps, and fire ants. There are many biting insects that bother people, but they rarely cause severe allergic reactions.
Moderator: What is a typical allergic to an insect sting?
Golden: A normal reaction to a sting is pain, swelling, and itching, which go away usually in a few hours. An allergic reaction can be local or generalized. Another word for generalized allergic reaction is systemic reaction or anaphylacsis.
Moderator: How do you know if you are allergic to stinging insects?
Golden: The diagnosis is made by a specialist, an allergist, by interviewing the patient and doing special allergy tests. If someone has had what I described as a systemic reaction, they should have venom skin tests done by an allergist to identify which venoms they are allergic to. The allergist can then recommend, based on the kind of reaction that the patient had, what kind of prevention would be the best idea for that person. For some people, it might be enough to be careful and carry an EpiPen, but for most people with insect skin allergy the best recommendation is to be immunized with venom treatment, because the allergy shots are highly effective to prevent dangerous reactions.
Moderator: Can you explain who needs an EpiPen?
Golden: An EpiPen is one kind of injector to deliver epinephrine, also known as adrenaline. It is a spring-loaded injector that makes it easy for somebody to give themselves an emergency injection that can be life-saving when there's a severe allergic reaction. An EpiPen is useful for someone to carry if they have had a severe allergic reaction in the past. This is true for insect sting allergy and for some food allergies or other causes of anaphylaxis.
I should point out that there is no other medicine that can counteract a severe allergic reaction, but sometimes even the EpiPen isn't enough; so when someone needs to use an EpiPen they should call 911, because they may need intravenous fluids or oxygen or other medicines.
Member question: My husband ends up at the ER every year because of bee stings. He is given Benadryl by IV and an epinephrine injection. Is there any desensitization program he can go on to have this reaction be not as severe? He's 57 years old and this is hard to deal with because we are limited in our outside activities and he loves to garden and do yard work and jog. He carries an EpiPen everywhere. Each time he ends up in the ER it is very scary. He gets blood red and breaks out in a rash.
Golden: This is an excellent example of the kind of person who really needs venom immunotherapy, which is the name for the desensitization that can almost guarantee no future reactions to stings. It is a type of allergy shot that some people are familiar with that is relatively safe and somewhat expensive, but it is covered by every insurance. The immunization with venom works so well that people can resume normal activities and in most cases, not even need an EpiPen.
Moderator: What is involved in venom immunotherapy?
Golden: Like all allergy shots, the first step is to get tested so the doctor can determine which ingredients to put in the shots. Usually, one or more shots, depending on how may many venoms the person is allergic to, is given every week for two to four months to build up the immunity. At that point the person is immunized, but they have to get a booster shot every month or two for quite a few years to keep up the protection. An allergist has to prescribe the treatments, but allergy shots can be given in any doctor's office or clinic.
Member question: Is the venom of any stinging insect in the U.S. any worse than the others? Is a hornet's sting more likely to cause problems than a honeybee, for example?
Golden: No. The reaction can be just as bad from the smallest yellow jacket or the biggest hornet. There's no difference.
Moderator: If you know you have an allergic reaction to bees, will you react the same to wasps?
Golden: There are several families of stinging insects.
Moderator: If you know you have a stinging insect allergy, aside from immunotherapy, what can you do so that you can still enjoy the great outdoors?
Golden: Unfortunately, the only thing even close to a guarantee of safety is the immunotherapy. Otherwise, it is hard to enjoy the outdoors when you know that a sting could cause a severe reaction.
I do have a safety tip: One of the sneaky ways that people get stung in a dangerous place is drinking from a straw or soda can, because yellow jackets love to go in soda cans, beer cans, and straws, which can lead to getting stung on the tongue or throat. So it's a good idea in general to avoid drinking from anything that you can't see inside of when you're outdoors.
Moderator: Another good reason to drink water!
Member question: It is three hours after a bee stung me. Am I out of risk for anaphylactic shock?
Golden: Anaphylaxis is what we call an immediate hypersensitivity reaction. It almost always starts in 10 to 20 minutes after the sting and rarely more than an hour after the sting. So if there is no severe reaction within an hour, there is almost no chance of anaphylaxis.
Anaphylactic shock is a dangerous drop in blood pressure that can lead to unconsciousness. Other kinds of anaphylaxis can cause swelling in the throat with trouble breathing. The mildest form of anaphylaxis is the itchy reaction with hives all over the body.
Moderator: What should you do if you're with someone who gets stung and appears to be having an adverse reaction?
Golden: What to do depends what kind of reaction.
Member question: I am allergic to bee stings, but take many medications and wonder how to tell if I should benefit from carrying some kind of kit to prevent serious reactions to a bee sting. I have epilepsy, immune globulin A and G is missing in my system, fibromyalgia, and take meds for posttraumatic stress disorder and major depression. I am concerned about medical interactions.
Golden: The first point is that the treatments are only recommended to people who have had a systemic reaction in the past. If you have had a systemic reaction, then the best treatment would be the immunization. The immunization, as well as the EpiPen, are both a problem in people who take beta-blocker medicines, because beta-blockers can aggravate allergic reactions. There is no other kind of medicine or medical condition that interferes or interacts with the treatment of insect allergy.
Member question: I assume insect allergies run in the family?
Golden: Not usually. Insect allergies are not more common in people who have other allergies or regular allergies.
Member question: If you've been stung before and did not react, can you assume you aren't allergic, or can the allergy pop up at any point in life?
Golden: The allergy can develop anytime, and the more times you get stung in your life the more the chance of getting allergic.
Member question: My son was stung by a yellow jacket when he was 3 and experienced a severe reaction (swelling in other areas other than the sting site). When he was 5 he began receiving allergy shots (every week for eight weeks, then every month). He is now 8 and receives 1 ml of the serum for yellow jacket venom. What is the likelihood he will outgrow the allergy or combat it as a result of the shots? I am looking for a percent chance. We are both anxious to discontinue the monthly shots.
Golden: When people receive venom injections, they can usually get the shots every six to eight weeks when they have been on it for a few years, and in most cases they can stop the shots after three to five years. But the decision to stop depends mostly on how bad the original reaction was. In children who had no trouble breathing and no severe dizziness, they can usually stop the shots after three years. But those with more severe reactions are advised to have five years or more of treatment. Children with mild to medium cases of insect allergy outgrow it in 70%-80% percent of cases over a 10-year period.
Member question: My son was stung by fire ants over 50 times when he was 13 months old and had an anaphylactic reaction to the bites. He went through immunotherapy until he was about 4 years old and has been bitten several times, one time up to 16 bites, and he did not have any reaction. The bites swell to about the size of a quarter, but sometimes not even that. The immunotherapist told us he could outgrow it by the time he is about 5 or when he has a major body change. What do you think is the risk that he would have another severe reaction or do you think his body has over come this? I also wonder if it could have just been a really bad strain of ants. When they stung my mother and me within the months around the time he was stung, our bites swelled very bad and we normally are not reactive to fire ants.
Golden: We do not know of any difference in different nests or groups of ants. So I don't think it was a bad batch of ants. The immunotherapy for fire ants has not been studied as much as for other insects, but we still believe the same three- to five-year plan would apply, and that would include your son.
Member question: Yesterday a red wasp stung my hand. I immediately took a Benadryl, but it continued to throb, even up to my elbow for several hours. Late in the evening, my husband suggested that I should have used meat tenderizer on it when the wasp stung me. I tried meat tenderizer mixed with water to make a sort of paste. I kept it on for 10 minutes or so, and washed it off. When I went to bed last night, the pain was minimal, but there was some swelling. I took another Benadryl, expecting to wake up this morning with no symptoms at all. Today my hand is swollen and red. It looks worse than it did yesterday, and is uncomfortable because of the swelling. Is there something I can do to expedite my recovery from this sting?
Golden: This seems to be what we call a large local reaction, and is difficult to treat, but is not dangerous. The meat tenderizer might work if you apply it within minutes of the sting, otherwise it will not help. Ice packs or cold compresses may help, especially when it's used in the first few hours before the swelling builds up. The only medicine that may make the reaction go down faster is cortisone steroid pills for a few days, which some doctors will prescribe for these large swellings.
Member question: My daughter was stung on the end of the nose and the whole side of her face swelled up; it took three days to return to normal. This was with giving her children's Benadryl twice a day. My question is do we need to get a bee sting kit to carry with her all the time?
Golden: The reaction also sounds like a large local reaction and the best treatment is to take prescription cortisone pills because Benadryl may help the itching, but it doesn't do much for the swelling. The chance of a large local reaction leading in the future to a systemic reaction to a sting is 5%-10% chance. This is not a big chance, so not every specialist recommends to carry an EpiPen, but it's not a bad idea, especially when camping or hiking far away from medical help.
Moderator: With children playing outside, it isn't always possible to know what stung or bit your child. What should you do if your child comes crying because of an insect "owie"?
Golden: It is always hard to tell for sure what exact insect caused the sting or bite, but what matters is to observe the child closely for at least 20-30 minutes for any signs of a systemic reaction like breaking out in hives all over or trouble breathing or severe dizziness. If none of those things happen within 30 minutes, then there is very little chance of anything dangerous happening after that.
Moderator: If you see a stinger or barb, should you pull it out?
Golden: Yes, you should remove the stinger, but you would have to remove it in seconds to prevent the venom from going into the skin. You can also put an ice pack or cold compress to slow down the swelling.
Member question: I've heard of people using bee stings to treat arthritis. Seems a bit like Russian roulette to me. Just how much danger are these people in if they don't know whether they are allergic or not?
Golden: Bee stings have been talked about as a treatment for arthritis and recently even for multiple sclerosis. There is no good scientific evidence to support this, but there are people who swear it worked for them. They usually have to get several stings every few weeks on a regular basis and there is a chance that they will get allergic to it.
Member question: If you are allergic to bee stings, should you stay away from things like eating bee pollen or using bee balm?
Golden: The allergy is to the venom and there is no venom in those commercial bee products. The people who should stay away from products like bee pollen are the people who are allergic to pollen.
Member question: Bees and wasps rarely bother me. However, the mosquitoes are always after me! Even with repellent lotions they just seem to swarm around me. The problem is that whenever mosquitoes bite me, I not only turn red and itch, but I also get shaky and sick at my stomach for about 15-20 minutes. Have you ever encountered this and what can I do?
Golden: Some people are allergic to mosquito bites and can get huge swellings that last for days. The shakiness or stomach reaction is hard to judge, because it's not quite typical of an allergic reaction, so it would be difficult to say why that happens. There is no test or immunization for mosquitoes.
Moderator: Can you have an allergic reaction to biting insects?
Golden: Some people actually are allergic to mosquito bites or fly bites or other biting insects, which causes large local swellings, but systemic reactions to biting insects are extremely rare.
Moderator: Dr. Golden, we are almost out of time. Before we wrap up for today, do you have any final comments for us?
Golden: One last comment would be for people to realize that if they have had a possible allergic reaction or systemic reaction to a sting they should not think that this was a fluke. It is very important to tell your doctor about this reaction and to ask about an allergy evaluation, so that you can get the best advice on what to do.
Let me add that most doctors do not have the expert knowledge of an allergy specialist, and the best advice would come from reviewing the problem with an allergy specialist. You can visit the website of the American Academy of Asthma, Allergy, and Immunology, www.aaaai.org, for more information.
Moderator: Thanks to David B.K. Golden, MD, for sharing his expertise with us. For more information, please go to our Allergy Center
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