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Allergic Diseases, S.C. | |
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| Steven H. Cohen, M.D. |
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| Stinging Insects When warmer weather arrives again, insects, including the stinging variety, come to life and provide us with an opportunity to interact with them. Most prominent of the stinging insects in the spring is the honey bee. They are seen around flowers and the flowering trees in our yards and in orchards. Insects are attracted to these plants, which need insect pollination, by the brightly colored flowers and the pleasant scents. The bees gather nectar and pollen which they take back to the hive to make honey so that the colony can survive. When we come in the way of their food gathering, they take this as a challenge and might sting. Fortunately, the bees in Wisconsin are the more docile variety and need to be provoked, in deference to the more aggressive Africanized bees found in the southwest, through Central America and into South America. Honey bees are far more interested in gathering nectar than stinging people. When they do sting, it ends their life. Their stinger has a hooked barb which sticks in the skin, and the venom sac, which is attached, is pulled out of the bee and it dies. This venom sac helps us differentiate a honey bee sting from a vespid (hornet, wasp or yellow jacket) sting which leaves no venom sac. The venom sac may continue to contract, injecting venom, and, therefore, needs to be carefully removed. The vespids are scavengers and have a tendency to be more aggressive. They are found around dumpsters, garbage, discarded soda cans and fruit that drops from trees in the fall. They are more easily disturbed and can sting multiple times, leaving no stinger; only redness, pain, and itching. Yellow jackets nest in holes in the ground, wood piles, stone walls and similar places. Hornets have paper nests that are football shaped and hang in trees. Wasp colonies in Wisconsin tend to be small with few insects, may be made of mud or paper, and are found in areas protected from the weather such as under the eaves of roofs. I got stung and had a lot of swelling. Is that an allergic reaction? Stinging insect venom has multiple components. Some cause pain, some cause swelling, and others may have a toxic effect. It is common to have swelling and pain with a sting. The swelling may be severe depending on the location. A sting on the finger has limited space to swell and may cause distortion of the digit. A ring that is not removed immediately may have to be cut to be removed. Swelling may involve an entire arm or leg but may be what we call a large local reaction if there are no other symptoms. Swelling, by itself, therefore, may not necessarily indicate an allergic reaction. My husband was stung on his arm and developed hives on his chest and abdomen. What should he do in the future? Allergic reactions occur within a short time of exposure. If a person is stung and develops hives two days later it is not of allergic significance. If a person is stung and develops hives within thirty minutes, it is suggestive of an acute allergic reaction. Even acute allergic or anaphylactic reactions may be self-limited, and the patient may survive with little or no medical intervention. This is not the preferred method of treating these reactions, however. Any one who has not been evaluated by an allergist and does not have medication to treat anaphylaxis should be given appropriate first aid, and 911 should be called. If the episode occurs far from any medical facility the patient must be transported to the nearest place he can receive medical care. About 100 people die each year in the United States from allergic reactions to insect stings. What needs to be done to evaluate a person for stinging insect allergy? As with any allergy patient, the first step is a detailed history. Where was the patient when he or she was stung, what type of reaction took place, what was the time sequence, how and where was the patient treated, and what instruction and treatment was given after the episode? Allergic reactions occur within a short time after the exposure- the shorter, the more likely they are to be allergic. With stings, beside the local swelling and pain, patients may develop hives, localized or generalized; generalized redness and warmth of the skin; respiratory symptoms, shortness of breath, cough, wheezing, or throat swelling sensation; faintness from low blood pressure, loss of consciousness or even cardiac arrest. With this information and a physical examination, skin testing with specific venoms is done to document which insect is the most likely culprit. A course of venom immunotherapy can be done to decrease the level of immunoglobulin responsible for the reaction. If may take up to four months to reach a therapeutic dose at which time the patient may feel safe. Patients are also given an Epipen (self-injectable epinephrine) and shown how to use the device if needed to treat a reaction "in the field." Venom treatment has been shown to be extremely effective in preventing life threatening reactions. REMOVING THE STING FROM SPRING MILWAUKEE - Allergy sufferers beware: Stinging insect season is approaching fast. For those people who have severe allergic reactions to insect stings, precautions must be taken to ensure a safe end to the summer. Up to 5% of Americans are at risk for a severe, potentially life-threatening allergic reaction from stinging insects, called anaphylaxis. Unfortunately, most people are not aware that they are allergic to insect stings until after experiencing a reaction. The most common stinging insects in the United States include yellow jackets, honeybees, bumblebees, paper wasps, hornets and fire ants. Before the sting It is important to take precautions before being stung to help avoid a potentially dangerous reaction: If you have experienced a severe reaction to insect stings or you think you may be allergic, consult with an allergist/immunologist to accurately diagnose your condition. An allergist/immunologist is the best qualified medical professional trained to manage the prevention, diagnosis and treatment of allergies and asthma. To find an allergist/immunologist in your area, call the AAAAI Physician Referral and Information Line at (800) 822-2762 or http://www.aaaai.org/physref/. Consider allergy shots, also known as immunotherapy treatment. Venom immunotherapy shots take effect within just a few months. Venom immunotherapy is the closest thing to a "cure" for allergic reactions. It is shown to be 97% effective in preventing future allergic reactions. Preventing the sting The following are steps that can be taken to keep from being stung when encountering flying stinging insects: * Avoid the "territory" of the stinging insect's nest. These insects are most likely to sting if their homes are disturbed, so it is important to have hives and nests around your home destroyed. Since this activity can be dangerous, hire a trained exterminator. * Remain calm and quiet, and slowly move away. * Avoid brightly colored clothing and perfume when outdoors. Many stinging insects are searching for food and could confuse you with a flower. * Be careful when cooking, eating or drinking sweet beverages like soda or juice outdoors. Keep food covered until eaten. * Wear closed-toe shoes outdoors and avoid going barefoot. * Avoid loose-fitting garments that can trap insects between material and skin. If any symptoms of anaphylaxis are present, call 911 immediately. Symptoms of Anaphylaxis:
Anaphylaxis is a medical emergency and may be fatal. If you or anyone else experiences any of these symptoms after an insect sting, call 911 to get emergency medical treatment immediately. After your symptoms are treated, contact your allergist/immunologist to learn about ongoing treatment options. It is extremely important that anyone who has had a severe reaction to an insect sting receives follow-up testing from an allergist/immunologist to determine the type of stinging insect that cause the reaction and receive a recommended treatment. Treating the Sting Allergic or not, insect stings cause discomfort. It is important to take the proper precautions to ease the pain. Use the following tips to help:
(Reprinted with permission from the American Academy of Asthma, Allergy & Immunology) |
11121 W. Oklahoma Avenue
West Allis, WI 53227 Tel: 414.545.1111