June 20, 2000 DENVER-Throughout the country, flying and crawling insects are preparing for a summertime assault.
“Unfortunately, pollens aren’t the only allergens in the air this time of year,” says Dan Atkins, M.D., a pediatric allergist at National Jewish Medical and Research Center. “Another bunch of allergens are flying around inside special injection devices that, when encountered, may threaten the life of those who are sensitive. These potential allergens are found in the venom injected by stinging insects.”
Picnickers all over the country have to contend with stings by yellow jackets, yellow hornets, white-faced hornets, wasps and honeybees. These stings can cause allergic reactions ranging from minor irritants, to serious medical problems.
More than 1 million Americans report allergic reactions to insect stings; about 50 people each year die from the stings.
Insect sting reactions fall into two categories: immediate and delayed. Immediate reactions occur within four hours of a sting. A normal reaction consists of localized pain, swelling and skin redness, lasting for several hours, at the sting site.
Another type of immediate reaction is called a “large local reaction” because it consists of a large area of swelling surrounding the sting site. “A large local reaction can be accompanied by low grade fever, mild nausea, malaise and fatigue,” Dr. Atkins says.
Treatment of local reactions in people without a history of insect sting sensitivity include aspirin for pain and ice to reduce swelling. For those with a history of large local reactions, taking an oral antihistamine (preferably nonsedating) is recommended.
“A third type of immediate reaction is the most dreaded: anaphylaxis. These reactions involve multiple organ systems simultaneously and most often begin within minutes of the sting although they can occasionally begin an hour or so later.”
Common signs and symptoms of anaphylaxis are flushing, itching, hives, swelling, sneezing, runny nose, swelling of the throat, breathing difficulties, nausea, abdominal cramping, vomiting and diarrhea.
In severe episodes of anaphylaxis, an irregular heartbeat and shock can occur. People who have had severe or anaphylactic reactions in the past should wear a bracelet identifying their insect sting sensitivity, be taught to self-administer injectable epinephrine, and be reminded to keep epinephrine and antihistamines available at all times. After epinephrine and antihistamines are taken following a sting, call 911.
Delayed reactions occur more than four hours after a sting. There have been isolated reports of serum sickness-like syndromes occurring about a week after a sting with hives, fever, malaise and joint pain. These patients are at risk for anaphylaxis with subsequent stings and are candidates for venom immunotherapy – shots for allergies to insect venom.
Venom immunotherapy is highly effective in preventing subsequent sting reactions. “After reaching maintenance doses of immunotherapy, 95 percent of venom-treated patients are able to tolerate single stings,” Dr. Atkins says. “And sting reactions that do occur are generally milder.”
He recommends that patients with a history of moderate to severe episodes of anaphylaxis following an insect sting be referred to an allergist. Adult patients who have a positive venom skin test generally are considered candidates for specific-venom immunotherapy. Children with skin symptoms alone have only a 10 percent risk of systemic reactions and aren’t considered candidates for skin testing or immunotherapy.
National Jewish Nurse Answers Common Insect Sting Questions
DENVER-Ann Mullen, R.N. is a National Jewish Medical and Research Center patient education expert. She answered the following questions about insect sting prevention.
Q: Are there any ways I can protect myself from insect stings while outdoors? A: I always encourage people to wear protective clothing while outside to decrease exposed skin. For example, wear long pants when hiking or mowing the grass, gloves while gardening and shoes or sandals rather than running around in bare feet.
Q: Is any color of clothing better? A. Wear white or light colored clothing; dark clothing and clothing with flowery designs is more likely to attract insects.
Q: Can I protect myself if I exercise outdoors? A: Use unscented deodorant and rinse off perspiration after vigorous exercise. Insects are attracted to the scent of deodorants and perspiration. Avoid any strong smelling perfume, cologne, hair oil, hair spray or lotions as insects may be attracted by the smell. Use insect repellants and keep insecticide available.
Q: How can I protect myself from insect stings during a picnic? A: Cover food and drinks at outdoor events as much as possible. The smell of food is a strong attraction for these insects. Don’t forget to cover garbage, as well.
Q: I’ve had severe reactions to insect stings in the past. What should I do to protect myself and let others know about my condition? A: I encourage wearing a medical alert bracelet or necklace stating that you are allergic to insect stings. The person with insect allergies should always carry an emergency pack.
Talk with your health care provider about exactly what to have in the emergency pack, but generally it should contain each of the medications needed to treat a sting reaction, such as an oral antihistamine—a syrup or chewable tablet—and an epinephrine injection device. If you have asthma, also keep a rescue inhaler and spacer in the pack. Ask your health care provider about potential symptoms of allergic reactions to insect stings. Also ask him or her to provide you with a written action plan, so that you know what to do if you have an allergic reaction. A small action plan card listing the actions to take and the importance of calling 911 or going to the closest medical facility once the medication is given is also helpful. Review how to take all the medications that are prescribed in your action plan. If an epinephrine injection device is prescribed, review when it should be used and demonstrate the correct technique for your health care provider. Talk with family about how they can help you follow your action plan.
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