Date: Fri 20-Oct-1995

Publication: Hea

Author: KAAREN

Quick Words:

bees-sting-venom

Full Text:

Bee Stings Pose A Mortal Threat To Some

B Y K AAREN V ALENTA

America Bee-ware.

Autumn is the season of attacking hordes of yellow jackets, whose annual

intrusion on our lives leaves a wake of pain and occasionally even death. This

summer's drought brought the problem on early as the lack of moisture and food

made these stinging insects even more belligerent than usual.

"In the past month we've had quite a few cases. A lot of these patients have

had true allergic reactions" said Richard J. Lee, M.D., a board-certified

allergy specialist in Danbury."

Less than five percent of the population is at risk for the most serious type

of sting reaction called "anaphylaxis," which can be life-threatening. But

people who have experienced an allergic reaction to an insect sting have a 60

percent chance of a similar or worse reaction if stung again.

Even medical professionals are at risk. Several years ago a young physician

who lived in Bridgewater died when she was stung by a bee in her backyard.

This summer the chief of immunology at UConn wound up in intensive care

because of a bee sting.

But most people are not allergic to insect stings and should recognize the

difference between a potentially life-threatening allergic reaction and a

normal or large local reaction, Dr Lee said.

"Some of the cases that we see are patients with large local reactions," he

said. "The person may be stung on the forearm but the arm from hand to elbow

or shoulder may swell up. I've seen patients start to hyperventilate - to have

a panic attack - because they are so frightened."

Even though the entire arm could swell to twice its normal size, the reaction

is considered only a grade two reaction, just slightly more serious than a

grade one reaction swelling of about the size of a 50-cent piece around the

sting site.

Usually grade one and grade two cases are treated the same: disinfect the area

and apply ice to reduce the swelling. Occasionally, if a large local reaction

persists for several days, antihistamines and steroids may be prescribed to

lessen the discomfort.

But when symptoms show up distant from the site of the sting, the condition

can be much more serious.

"If you are stung on one hand and develop hives on your other arm that is

statistically more important because it means the reaction is taking place

throughout your body - it isn't localized," Dr Lee said.

This type of reaction, considered grade three, often can become a grade four

reaction if the person is stung again. Symptoms of an allergic reaction or

anaphylaxis may include one or more of the following:

Hives, itching and swelling in areas other than the sting site.

Tightness in the chest and difficulty in breathing.

Hoarse voice or swelling of the tongue.

Dizziness or a sharp drop in blood pressure.

Unconsciousness or cardiac arrest.

This type of reaction can occur within minutes after the sting and can be

life-threatening.

An allergic reaction is treated with epinephrine, either self-injected or

administered by a doctor. In some cases, intravenous fluids, oxygen and other

treatments are necessary as well. Once stabilized, these patients are

sometimes required to stay overnight in the hospital under close supervision.

People who have had previous allergic reactions and rely on the protection of

epinephrine must remember to carry an adrenalin kit containing the drug with

them wherever they go. Also, because one dose may not be enough to reverse the

reaction, immediate medical attention following an insect sting is

recommended.

Allergic reactions to insect stings usually can be prevented with venom

immunotherapy, a treatment that involves administering gradually increasing

doses of venom that stimulate the immune system to become resistant to a

future allergic reaction.

"The dosage gradually is built up until it is the equivalent of two bee

stings," Dr Lee said. "When it reaches that level, the rate of allergic

reactions drops 97 percent."

"Usually when we see patients with grade three or worse reactions to an insect

sting, we recommend skin testing to see if there are IGE antibodies present,"

Dr Lee said. "That tells us if they are allergic."

It is particularly important for persons who spend a lot of time outdoors,

such as golfers, gardeners or hikers, to take precautions, he said.

You can lessen your chances of an insect sting by taking certain precautionary

measures. Yellow jackets will nest in the ground and in walls. Hornets and

wasps nest in bushes, trees and on buildings. Use extreme caution when working

or playing in those areas and never walk barefoot in the lawn.

Avoid insect attractants such as perfumes, hair sprays and other fragrances.

Cover garbage cans and exposed food at picnics. Try to reduce the amount of

exposed skin when outdoors and don't wear bright colors.

"Get someone else to mow the lawn," Dr Lee advised.

Persons who have some other medical conditions, such as serious hypertension

or diabetes, are more prone to have serious allergic reactions to insect

stings and are much more difficult to treat, he said.

A booklet containing most of this information has been written by the American

College of Allergy, Asthma and Immunology. Free copies are available by

calling 1-800-23 STING. For the names of board-certified allergists, call the

American College of Allergy, Asthma and Immunology at 1-800-842-777.