Combating Stinging Insect Allergies
Jul 26, 2017 12:11PM
● By Lisa Sullivan, MD
Editor’s note: Stinging insects, such as bees, wasps and hornets, are with us all summer and can cause reactions at any time if they sting. But by August and September, wasps such as yellow jackets get particularly aggressive as colonies transition from reproducing worker insects to producing new queens and males, and seek out not just protein, but carbohydrates such as sugary foods from human gatherings. In addition, wasps are more aggressive defending underground nests in lawns and backyards as the new colonies form. Even more docile colony bees (such as honeybees) are more easily provoked as they prepare their colonies for colder weather. Unfortunately, these insects that share our outdoor space may bring unintended harms to children and adults alike if they sting.
It is important to know that anyone can develop a severe insect allergy and even non-allergic individuals can experience a lethal reaction from multiple stings. Anaphylaxis from an insect sting is a systemic, full body, allergic immune response that can be life-threatening. Most people associate anaphylaxis with hives or trouble swallowing, but this is only partially correct. Anaphylaxis can affect all body systems in different combinations, and thus may fail to produce a telltale hive or swallowing clue until it is too late.
It is better to think of anaphylaxis as a rapid, downhill spiral of symptoms that can involve any body part or organ, generally within minutes to an hour after it is triggered by an insect sting. For example, if a friend is stung and suddenly becomes ill with vomiting, diarrhea and dizziness, we should suspect anaphylaxis, and not the stomach flu. The same would be true if someone started having problems with their asthma shortly after a sting. Therefore, if someone experiences any symptom other than localized swelling within the first hour of a sting, it is always best to administer injectable epinephrine immediately, and then call 911.
A high-risk individual with an insect venom allergy may choose to inject epinephrine even before symptoms appear. This drug works “like magic” to quickly reverse the symptoms, but this effect may be short-lived. Carrying a spare auto-injector (such as an EpiPen or AuviQ) and getting to the emergency room quickly is a must. If with someone that becomes a victim to anaphylaxis or passes out after being stung, don’t hesitate to locate their epinephrine auto-injector and use it. The risk of harm from using it when not needed is negligible compared to the risk of not using it when it’s desperately needed. Also, if they have forgotten or don’t have an injector and appear to be in trouble, don’t be shy to make an announcement. It is likely that someone nearby has one on hand. Even a child’s dose is better than none at all.
A more common and less worrisome occurrence is when someone develops a large, localized swelling around the insect sting. Although uncomfortable, they are unlikely allergic, but that is best determined in consultation with a board-certified allergist. When insects sting, most people experience an immediate localized burning and swelling that can persist for days, due to the venom toxins at the site of injury. The amount of venom injected and the person’s immunity in the skin will determine how large the localized reaction becomes. As long as a local reaction remains limited to the skin and does not appear in other areas of the body, it is generally not life-threatening. An exception would be when a local reaction occurs near the mouth or neck; it may directly impinge on the airway. Local reactions neither increase nor predict an individual’s risk for systemic/anaphylactic reactions. They do, however, increase the likelihood of having larger local reactions in the future.
Lisa Sullivan, M.D., of Highland Park, specializes in allergy, asthma and immunology for all ages, with offices in Buffalo Grove and Vernon Hills. For more information, visit LisaSullivanmd.com.
Avoiding Insect Sting Reactions
Those that suspect a venom allergy should be formally evaluated and tested by an allergist. If an allergy is confirmed, then the standard of care is to receive three to five years of immunotherapy (allergy shots). Once maintenance immunotherapy is reached, at about three to six months, a patient can enjoy an estimated 97 percent protection against severe sting reactions.
- Always carry an epinephrine injector and don’t be afraid to use it.
- To avoid getting stung, have a professional eliminate nests on the property.
- Avoid perfume, cologne and fragrant soaps.
- Choose red colors over black. Dull clothes without designs, preferably red or grey tend to be less interesting to insects. One theory is that because insects see into the UV range to locate flowers, they ignore colors that don’t show up under a black light.
- Wear a cap or hat.
- Move slowly. If bees or wasps sense danger, they produce a scent to attract others in their colony.
- To lessen the chance of a severe reaction, remove all stingers immediately with the swipe of a fingernail or credit card. How fast the stinger is removed is more important than the method used.