MEDICAL SURFARI; BEES, HORNETS, WASPS AND YELLOW JACKETS

It has happened to all of us walking along enjoying the feeling of fresh grass between your toes, when you suddenly feel the sharp, hot, painful sting by an insect by the order Hymenoptera. These are common throughout the United States and while it may take over 100 bee stings to inflict a lethal dose of venom in most adults, one sting can cause a fatal anaphylactic allergic reaction in a hypersensitive person. Death in the United States from bee stings is three to four times more likely than from snake bites.

Most people are not allergic to insect stings and should learn to recognize the difference between a true allergic reaction versus a large local reaction as this will help prevent unnecessary medical expense and fear. The "triple response" is the body's normal response to an insect sting. The triple response is pain, swelling and redness and is usually confined to the region of the sting. This response may even extend beyond the local site of the sting and affect the entire limb or region of the sting, resulting in a massively swollen limb that may persist for several days. In hypersensitive individuals an extreme allergic reaction can occur called anaphylactic shock. This is a florid antigen-antibody reaction that can be life threatening. The symptoms of "anaphylaxis" (anaphylactic shock) may include one or more of the following: dizziness, rapid heart rate, abdominal cramps, wheezing or difficulty breathing, hives and agitation as well as a very hoarse voice or swelling of the tongue. These symptoms may progress and lead to a sharp drop in blood pressure as well as unconsciousness and/or cardiac arrest. Anaphylaxis typically develop within a few minutes; therefore, call 911 or rush the person to the nearest emergency center if they develop any of these signs or symptoms. Sixty percent of the people who have had an allergic reaction to an insect sting have a chance of a similar or worse reaction if they are stung again.

If you are stung by one of these winged insects the sting site should be inspected as some bees and yellow jackets can leave a barbed stinger and a venom sack in the skin that continues to release venom. If you see a stinger remove it immediately by gently scraping it with a knife blade or fingernail. Do not try to remove it with tweezers and be careful not to squeeze or grab it as this may inject more venom into the sting site. The venom of bees contains, among other components, peptides and non-enzymatic proteins. So, try applying a paste of one teaspoonful of meat tenderizer combined with a few drops of water. Apply this directly on the sting and the enzyme, papain, in the tenderizer will help break down these proteins injected by the insect. This is not just some of Granny Clampett's 'possum tail/eye of newt' remedy -- it really works. If you don't have meat tenderizer handy try applying a paste of baking soda to relieve the itching and swelling and cool the sting with ice. Over-the-counter antihistamines can also help relieve the itching and some of the swelling. Be certain to elevate the body part that has been stung if possible.

Severe allergic reactions to insect stings can be prevented with immunotherapy, a highly effective vaccination program that can reduce the risk of future anaphylaxis. Anyone who has had this type of reaction in the past should carry a sting kit that includes a preloaded syringe containing adrenaline, which resists and/or prevents some of the effects of the severe allergic reaction. If you have a history of this type of reaction be sure to discuss this with your physician and have your doctor teach you how to use the sting kit.

Worldwide Web Resources

Allergy, Asthma & Immunology Online

allergy.mcg.edu/

This site provides "Allergic Reaction to Stings from Hornets, Wasps, Bees and Yellow Jackets: Patient Information."

Doctors' Answers to "Frequently Asked Questions" -- Insect Bites

www.druginfonet.com/faq/faqinsct.htm

Problems with specific types of insects is addressed in this site.

Dr. Scott Gibbs is a Cape Girardeau neurosurgeon and editor-in-chief of Mosby's Medical Surfari. You may e-mail questions to him at drgibbs@semissourian.com or write in care of the Southeast Missourian, P.O. Box 699, Cape Girardeau, Mo., 63702-0699.