MEDICAL CONDITIONS
Stinging Insect Allergies
What are stinging insects?
The majority of stinging insects in the United States are from Bees, Yellow Jackets, Hornets, Wasps and Fire Ants. Except for fire ants all of these insects are found throughout the United States. Fire ants are at this time found only in the southeastern United States.
Who is at risk?
Over 2 million Americans are allergic to stinging insects. The degree of allergy varies widely. Most people are not allergic to insect stings and most insect stings result in only local itching and swelling. Many, however, will have severe allergic reactions. 50 to 150 deaths occur each year from these stings, and up to a million hospital visits result form insect stings. If you are known to be allergic to insect stings, then the next sting is 60% likely to be similar or worse than the previous sting. Since most stings occurring in the summer and fall, you are at greatest risk during these months.
What types of insect sting reactions occur?
Most insect sting reactions are not allergic and result in local pain, itching, swelling and redness at the site of the sting. Some extension of the swelling is expected. Local treatment is usually all that is needed for this type of reaction. Disinfect the area, keep clean and apply ice. If the swelling increases antihistamines and possibly steroids may be needed. Occasionally, the site will become infected and antibiotics are needed. Large local non allergic reactions (occurring 10% of the time) are often alarming and can persist for days. This is usually not a cause for concern and are best treated as above.
The most serious reaction is the allergic reaction. The allergic reaction to insect sting varies from person to person. The most serious is called anaphylaxis and as indicated above can be fatal. Severe reactions are suspected if a person experiences hives and intense itching at sites other than the sting site. Difficulty breathing, swallowing, hoarseness, swelling of the tongue, dizziness and fainting are signs of a severe allergic reaction. These types of reactions usually occur within minutes of the sting, but have been known to be delayed for up to 24 hours. Prompt treatment is essential and emergency help is often needed.
How is a severe allergic reaction immediately treated?
Honey bees stingers are barbed stingers which are left behind in the person's skin and then the bee dies- a bee sacrifice! If the stinger is removed by pinching the stinger, more venom is injected into the skin. It is better to remove the stinger by gently lifting the stinger using a finger nail or knife edge to 'flick' the stinger out of the skin. Other stinging insects do not leave stingers behind and this technique does not apply.
An allergic reaction is treated with epinephrine (adrenaline). Several self-injectable devices are available by prescription including Epi-Pen, ANA-Kit, and others. These devices are filled with the epinephrine to be injected in to the subcutaneous tissue or muscle, preferably into the front of the thigh. These self-injected devices usually contain only one dose and, on occasion, more than one dose is needed. Venom extractors are commercially available, but they have not been demonstrated to have any benefit.
If a serious sting occurs medical attention can be necessary, even if epinephrine is used and all seems stable! The allergic reaction can subsequently progress and become more serious after epinephrine has worn off. Sometimes epinephrine is not enough and intravenous fluids or other treatment is needed. If you are known to be seriously allergic to insects you must remember to carry the epinephrine at all times especially when out of reach of medical care (such as in the woods or even on an airplane). If epinephrine is not available when you are stung, contact a doctor as soon as possible. In addition to epinephrine, an oral dose of antihistamine (like Benadryl) can reduce the symptoms of an allergic reaction. Antihistamines take effect in about one hour. Ultimately, however, it is crucial to first avoid the sting, so such treatment isn't necessary!
How can I avoid insect stings?
Obviously the best treatment is avoiding the insect sting. Certain precautionary measures will greatly decrease your chances of being stung. Honey bees are not aggressive and will usually not sting unless disturbed or injured. The majority of honey bee stings are on the bottom of the bare foot while stepping on the bee. Avoid walking bare foot on lawns where honey bees forage on succulent clover. Yellow jackets nest in the ground and in walls. Caution is used with unusual forms in walls and mound in the ground. Hornets and wasps often nest in bushes, trees and under roofs. Use caution too in these areas and in selecting employment requiring exposure to these conditions. Bright colors attract insects seeking nectar. Stinging insects are attracted to food and strong smells. Avoid open food as in garbage cans, dumps and open picnic areas. Do not wear perfumes, hair sprays, and colognes.
It is interesting that bees find black color very irritating and blue is comforting to them. Remember this when selecting your summer bathing attire. If you think that insect repellent of any kind is effective in repelling these stinging insect you are mistaken and in fact may attract them. Please do no use except for reasons other than to avoid stinging insects.
What can I do about becoming immune to insect allergy?
All persons who have had a significant reaction to a stinging insect should be evaluated by an allergy specialist for possible venom immunotherapy (allergy shots that develop an immunity to insect allergy). If indicated by a well recognized protocol, selected patients with significant sensitivity and specific symptoms should undergo allergy injection therapy for stinging insect allergy. Not all patients who have stinging insect reactions should get allergy shots, but many should. Allergy immunotherapy against stinging insects in these selected patients is almost 100% effective. This type of treatment usually involves gradual twice weekly increase in the venom dose over 10-20 weeks. At this dosage level (achieved by 90% of patients) a "maintenance" dosage every 4-8 weeks is given. After approximately 5 years reevaluation discontinuation of the venom shot is considered. The risk of severe adverse reactions from this venom therapy is minimal ( less than 0.2%) and to date no deaths have been reported.
Knowledge in the field of stinging insect allergy has expanded greatly in the last 10 years and will likely continue to do so.
The U.S. Department of Agriculture recommends the following: - Avoid disturbing likely beehive sites, such as large trees, tree stumps, logs and large rocks.
- If a colony is disturbed, run and find cover as soon as possible. Running in zigzag pattern may be helpful.
- Never stand still or crawl into a hole or other space with no way out.
- Do not slap at the bees.
- Cover as much of the head and face as possible, without obscuring vision, while running.
- Once clear of the bees, remove stingers and seek medical care if necessary, especially if there is a history of allergy to bee venom.
Stinging Insect Allergies At A Glance - Severity of reactions to stings varies greatly.
- Avoidance and prompt treatment are essential.
- In selected cases, allergy injection therapy is highly effective.
- The three "A's" of insect allergy are Adrenaline, Avoidance and Allergist.
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