FAMILY MEDICINE® COLUMN

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

TO "BEE STING KIT" OR NOT TO "BEE STING KIT," THAT'S THE QUESTION

Question: My 14-year-old daughter had quite a reaction to a bee sting last summer. The sting spot got as big as a baseball and was quite uncomfortable. It took about a week for it to go down. Should I get a bee sting kit in case she gets stung again this summer?

Answer: It is hard to get an estimate of how often people are stung by bees because most episodes don’t get recorded. When I ask my patients about this, however, almost everyone has been stung at least once in the past. Bees aren’t very big, but they certainly are not defenseless!

About 20 percent of the population has antibodies against bee venom. This means that a previous bee sting has triggered antibody production and that the person’s immune systems is prepared to put up a furious fight if they are stung by a bee again. For about one percent of the population the reaction is so intense that a bee sting can cause a serious -- sometimes fatal -- allergic reaction called anaphylactic shock. In these people, a sting may result in major swelling, difficulty in breathing, and even life-threatening shock. In fact, about 50 people die each year in the U.S. from bee stings.

Fortunately, however, bee stings do not present a major medical problem for most people. Instead, a sting produces a small amount of redness and swelling at the sting site with some associated itching or discomfort. Usually, these annoying but mild reactions clear up by themselves in a matter of hours or perhaps as long as a day.

Some individuals, like your daughter, have a more dramatic local reaction to the sting. “Local” in this context means that the reaction was at the sting site and did not involve breathing or circulatory problems. This type of response is midway between those of us who only have the annoyance of a sting and those who have shock as a consequence of exposure to bee venom.

Individuals who have a large local reaction are likely to have a similar response to subsequent bee stings. About 5 percent, however, will develop anaphylactic shock with subsequent stings. This is important since a bee sting kit is only helpful for those who experience the most severe reactions -- shock.

A bee sting reaction with shock is potentially life threatening. Consequently, a prompt trip to the emergency room is called for. The immediate administration of the drug epinephrine can be life saving in bee sting shock. Epinephrine must be administered by shot, so a simple device has been developed that makes it easy for anyone to give himself or herself this drug. This user-friendly medical device is called an Epipen, and it is available by prescription.

My recommendation for your daughter is to avoid getting bee stung again. In this case “bee” means yellow jackets -- the most common culprit in “bee” stings -- wasps, hornets, honeybees and fire ants. Always wear shoes when going outside, avoid wearing shiny clothing or jewelry, and picnic where the bees aren’t. The most important preventive measure, however, is to avoid swatting at these annoying critters. Even if one lands on you, you can usually avoid a sting by simply holding still until it flies away. Trust me on this -- it is nerve-wracking, but it works.

The chance of your daughter having an anaphylactic reaction to a bee sting is small, so an Epipen or other bee sting kit is not likely to be needed. Despite the low probability of needing one of these kits, it could be a form of good insurance. Talk to her doctor about it.

"Family Medicine" is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701. Past columns are available online at http://www.FamilyMedicineNews.org.