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

"ONCE STUNG, TWICE CAUTIOUS" SHOULD BE READER'S MOTTO

Question: Last summer I became very sick after a bee sting. I had trouble breathing and got quite swollen. Fortunately, the emergency room doctor took care of me right away. Now I'm concerned about getting stung again this year. Do you have any recommendations?

Answer: In about 3 percent of the population, a bee sting can cause a serious allergic reaction, just as happened to you. In these people, a sting may result in major swelling, difficulty in breathing, and even life-threatening shock. In fact, about 40 people die each year in the U.S. because of reactions to bee stings. Fortunately, however, in most people bee stings do not present a major medical problem. They produce a small amount of redness and swelling at the sting site with some associated itching or discomfort. But usually, they clear up by themselves in a matter of days.

Bee sting reactions are like many conditions in that the first step in treatment is avoidance of the sting in the first place. So, here are some things you can do to minimize the chances of being stung. First of all, avoid wearing flashy clothing and shiny jewelry which attracts bees and other flying insects. Also, don't use perfumes and scented soaps and lotions when you are going outdoors. One very obvious precaution is to avoid going barefoot or wearing open-toed shoes when walking in grass or in the woods. Don't wear clothing made of wool or leather because these materials seem to attract the little pests. If you plan to have a picnic, make sure to seal all food in plastic or other suitable containers until it's needed, and dispose of food waste either by burying it or resealing it until you get home. And if the bees come to your picnic despite your best efforts, don't aggravate them. Don't try to chase them away or frantically shake and swat at them if they land on you. Hold still and wait for them to fly off you, or blow at them but don't swat! I know this is hard to do, but it will probably keep you from getting stung.

In spite of your efforts to avoid getting stung, you may still have that undesired encounter with one of the stinging pests. Your reaction last year was caused by a bee, but wasps, hornets and fire ants can all cause serious allergic reactions in some people. However, honey bees are more than twice as likely to do this. Getting stung by a creature other than the type that caused your reaction last year is less likely to cause a serious reaction than is a sting from one of the same type.

If you or somebody you're with is stung by a bee and begins to have an unusual reaction, get to an emergency room right away. Time is of the essence, because unless a drug like epinephrine is administered promptly the person's symptoms can quickly get worse. And since you had a serious reaction last year, you are at increased risk of having a similar reaction if you are stung again. I'd recommend that you keep epinephrine at arms-reach because a shot of this drug can reverse the life-threatening effects of what doctors call an "anaphylactic reaction" to a bee sting. It will help open the breathing passageways and keep the blood pressure up to a near normal level.

The convenient way to give yourself a shot of epinephrine is with an EpiPen. It is a special syringe which is already filled with epinephrine. It is designed so that almost anyone can give themselves a shot if the occasion should arise. I recommend that my patients who have experienced bee-sting reactions purchase at least two EpiPens so that they can carry one with them and keep one in a convenient place at home.

People who are seriously allergic to bee stings can also get shots to desensitize their bodies to the bee venom. Your family doctor or an allergy specialist can tell you more about them. Normally, you have to take them for three years to be protected from future stings, and in some people the protection wears off after several years.

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.