FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

SON AT "MINIMAL RISK" FOR BEE STING REACTION

Question: My son was stung by a bee last summer. It caused his arm to swell tremendously. Does this mean that he is allergic to bee stings, and should we get a bee sting kit for him?

Answer: Bee stings are quite common, so your question is an important one. Most bee, wasp or hornet stings produce a small amount of redness and swelling at the sting site. There is usually a degree of itching and discomfort with this reaction. Unfortunately, up to 3 percent of the population of the United States has more serious allergic reactions to stings that require immediate medical attention. These reactions involve extensive swelling at the site of the sting, difficulty breathing and a collapse of the circulatory system you probably know as shock. About 40 of the unfortunate individuals who have this type of severe reaction die each year as a result of stings.

The reaction your son experienced is somewhat less than a life-threatening allergic reaction, but it clearly was an allergic reaction. I could find no scientific study that measured the risk to a person who has had a local allergic reaction to a bee sting of later experiencing a severe allergic reaction. However, based on my experience, I'd say his risk of a more severe reaction to a later bee sting would be relatively minimal.

Even though his risk of a life-threatening reaction is small, I think it is still a good idea to talk with him about avoiding bees and bee stings. Children often provoke bees or wasps by wildly swatting at them if they come within an arm's reach. This action certainly makes it likely that a person will be stung. The proper response is to sit still and let the insect pass on by. If several are circling around, as they often do at picnic sites, just slowly move away to another location. Also, I'd recommend that you specifically instruct your son to hold still if a bee or wasp lands on him. Trying to brush it off or swatting at it will just increase the changes of being stung.

The immediate treatment for a local allergic reaction one which produces considerable swelling at the sting site like your son had last year is to apply ice to the bite and to also take an oral antihistamine such as Benadryl. More severe systemic reactions, in which the individual experiences breathing or circulatory difficulties, require the medication epinephrine in shot form and immediate care at the nearest hospital. I think the most effective way for most individuals to give someone this life-saving shot of epinephrine is with a special pre-loaded syringe called an EpiPen for adults or EpiPen Jr. for children. The epinephrine and antihistamine are components of all bee sting kits.

Individuals who have severe allergic reactions to bee stings are very likely to have a subsequent bad reaction to the next sting. These unlucky individuals should see an allergist to begin bee sting desensitization shots. These are allergy shots against bee sting venom. The shots are quite successful at preventing further reactions. About 99 percent of those who continue the shots for three years will be safe if they are stung. There is some variability in the length of time these shots provide protection after the three-year series is over. Most individuals will be protected for at least two more years, and others may be protected for a lifetime.

I think you should talk to your son's doctor about bee stings, bee sting kits and perhaps about desensitization shots.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.