Written by Linda Yau, M.D., F.A.C.P.
July 12, 2015
Bees and I do not get along. A playmate in my first grade class in Corvallis, Oregon stumbled upon a yellow jacket nest, so one of my earliest memories is standing in a classroom of screaming children while bees swarmed the room. While pregnant with my first child and taking the Internal Medicine Board Examination, a bee stung my upper lip from a juice can. Because of the pregnancy, I could not take many medicines. After a week of hearing scratching noises in our ceiling when first moving to our house, my husband and I awoke to have hundreds of bees everywhere since they chewed through the wood from the attic. It was like a scene from a horror movie. These personal experiences, as well as treating patients with bee stings has made me wary when I see wasps or bees hovering at a picnic or outside event.
Thankfully I have never suffered from anaphylaxis to bee stings. Anaphylaxis is defined as a serious allergic reaction with symptoms of throat swelling, facial swelling, shortness of breath, drop in blood pressure, loss of consciousness, nausea and vomiting. In the U.S., at least 40 deaths per year are reported from anaphylaxis due to bee or wasp stings.[i] If you have these symptoms due to a bee sting, call 911 and go directly to the nearest emergency department. If you have an auto injector with epinephrine, use that immediately. Once epinephrine is administered, the emergency department also gives antihistamines such as Benadryl, oxygen and inhalers such as Albuterol (which open up the airways).[ii] Antihistamines block histamine, which is a substance that is responsible for many of the symptoms of allergies. Commonly used non-sedating antihistamines go by the brand names Claritin, Allegra and Zyrtec. Often corticosteroids such as prednisone are given to decrease inflammation, local skin reaction to the sting and theoretically prevent a possible recurrence of symptoms (biphasic reaction) hours later.
Anyone who develops anaphylaxis to bee stings should see an allergist for skin testing and evaluation for allergy shots. These types of shots are called immunotherapy and can lower the risk of anaphylaxis to less than 5% and also decrease the allergic reaction in general. Generally these shots should be given for 5 years as studies show better efficacy after this time frame.
Most people do not suffer anaphylactic shock after a bee sting. Local reactions are much more common. Usual treatment includes cold compresses/ice, antihistamines , such as Benadryl or Zyrtec and topical steroids such as hydrocortisone. Oral steroids such as prednisone can help patients who have significant swelling at the site of the sting.
The mainstay of prevention is to avoid getting stung. Wear long sleeves and long pants when gardening and be aware of your surroundings so as not to stumble into a yellow jacket nest as my classmate did in first grade. If you have severe reactions to bees, always carry injectable epinephrine (also called Epipen, AuviQ and Adrenaclick) with you to treat anaphylaxis. If stung, immediately remove the stinger with a blunt edge such as a credit card, apply ice and take an antihistamine. If there are any signs of anaphylaxis such as throat closing or swelling, immediately inject with epinephrine and call 911 to go to the nearest emergency department to get more advanced care.
This summer, stay healthy by avoiding wasps and bees and be prepared to treat stings. Enjoy the great outdoors and the honey that they make, but be cautious when you see those yellow and black flying insects!
[i] Casale, T.B. and Burks, A.W. Hymenoptera-Sting Hypersensitivity New England Journal of Medicine, 2014; 370:1432-9.
[ii] http://www.aafp.org/afp/2003/0615/p2541.html
Other references:
http://www.aaaai.org/conditions-and-treatments/library/allergy-library/stinging-insect-allergy.aspx\
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