Drs. Michael and Adrianne Vaughn
115 Gallery Circle
San Antonio, TX 78258
(Stone Oak MRI/Urgent Care Bldg.)
Bee Sting Allergy
Hymenoptera is the scientific name for sting insects, which includes bumblebees, honeybees, wasps, hornets, yellow jackets and fire ants. These insects are responsible for many fatal and near fatal episodes each year. Severe anaphylactic reactions to stings include: swelling of the throat, asthma, and a fall in blood pressure, which may lead to cardiac arrest. About 50% of people who experience a systemic allergic reaction will have a recurrent reaction when re-stung. Children who experience only hives after a sting have a low incidence of severe reaction on re-sting and do not usually require venom immunotherapy, in contrast to adults with hives. Adults and children with large local reactions are not usually candidates for allergy shots either, since re-stings usually result in reactions that resemble the prior exposure and is rarely life threatening.
Avoiding re-stings by bees and ants is often difficult in anyone who is active outside during the spring, summer or fall. It is therefore imperative that anyone who has suffered a severe reaction to bee or ant stings should always carry an epinephrine self-injector. If an allergic person is stung and begins to develop allergic symptoms, epinephrine should be injected immediately and EMS should be contacted for transport to an ER for monitoring. Recurrent symptoms often are noted after the short-lived effects of epinephrine wear off. Taking a histamine receptor 1 (H-1) blocker such as Benadryl, CTM, Dimetapp, Atarax, Claritin, Allegra or Zyrtec is also highly recommended if these drugs are available to you. Other drugs that are beneficial for treating severe allergic reactions such as hives, Angioedema and Anaphylaxis are the histamine-2 receptor blockers. These drugs are typically prescribed for stomach acid problems, but are also useful in combination with H-1 blockers for allergic reactions. The most common H-2 blockers are Tagamet, Pepcid, Axid and Zantac.
On arrival to the emergency room, the doctor should provide you with oral or injected IV steroids to prevent a later relapse. Two (2) hours of ER monitoring is usually sufficient to allow for return to your home, provided you have no persistent symptoms and you go immediately to the pharmacy to replace your used epinephrine auto injector. In the unlikely but possible event of symptom recurrence after leaving the ER, repeat the epinephrine injection and call 911 for transport back to the ER.
Venom Immunotherapy to stinging insects involves a progressive series of injections of venom from the offending species to build a tolerance against a recurring natural sting. Allergy shots for Hymenoptera protect about 97% of those who are re-stung and in the remaining 3%, reactions to restings are generally milder than the initial reaction. Typically, shots are given weekly until the maximum dosage is reached and then continued monthly for 3-5 years. The loss of reactivity to the venom on skin testing appears to be a good indicator for successful therapy and those that maintain skin test reactivity may be required to continue shots more than 5 years. Persons who are allergic to stinging insects and who live active outdoor lifestyles are strongly advised to undergo "Allergy shots." Remember that stinging insects are drawn to bright colors, perfumes, food, and drink odors. Avoid these attractants when you are outside.
Asthma & Allergy Associates