Summer has its sting

Health: For those who are allergic to insect bites, that cute buzzing bee can be a mortal threat.

July 11, 1999|By Patricia Meisol | Patricia Meisol,Sun Staff

Buzz. Buzz. Zing.

In the back yard under the crab apple tree, only one thing can abruptly ruin a lazy summer day: the sting of a bee, hornet or wasp. The same insects that float from stem to stem, coloring summers with flowers as they search for pollen, are also killers.

Millions of people could avoid life-threatening allergic reactions if they'd speak up -- to a doctor. You know who you are -- you've already had one severe reaction to an insect sting. In all likelihood, people who have had one bad experience are candidates for a purse or pocket-size prescription of the drug epinephrine.

Some also may be eligible for venom immunology, the 20-year-old preventive series of shots of venom that is almost 100 percent perfect in building a patient's immunity and blocking the reaction. It is taken weekly for two or three months, then repeated every one or two months for up to five years.

But most people don't know about either, a fact that leaves allergists almost as angry as bees in late summer. Allergists have gone on the attack, giving information to the places patients could obtain it -- emergency rooms and general doctors' offices.

Venom immunology is reserved for the severely allergic, and a person can be tested for reactions and treated with it only after experiencing a first severe reaction.

"But the biggest thing is knowing it is available and no more dangerous than any other allergy shot," says Dr. David Golden, associate professor of medicine at Johns Hopkins University and a specialist in allergies, particularly those caused by insect stings.

"Yes, allergic reactions to shots can happen," he says, but no more often than reactions to shots for grass or dust mites. The therapy is also safe for pregnant women, he says.

Golden was the lead author of a 1989 study that determined an estimated 3 percent of adults and 1 percent of children have had allergic reactions to insect stings. The big surprise in the study was that nine of 10 people who suffered a bad reaction to a sting never told their doctors. As many as 10 million people are hypersensitive enough to require extra protection; but many who know they are at risk shrug it off, assuming they will not be stung again. Sometimes they're right, but sometimes, the next sting brings an even more severe reaction.

Nationwide 50 people die each year from insect bites, and many more seek critical care in hospital emergency rooms. Everyone reacts to stings of bees, wasps or hornets. Most frequently, though, the swelling and itching is local -- that is, confined to the area of the bite or at least to the affected arm or leg.

The reactions that occur far from the sting site are what concern doctors. These so-called generalized or systemic reactions to insect bites are readily apparent. Minutes after the sting, itchy welts or hives break out all over the body. In 10 to 30 minutes, a person may feel his throat tightening, have trouble breathing, feel dizzy or pass out. The loss of consciousness is caused by low blood pressure.

Allergic reactions are unpredictable. Golden says people can be stung 50 times and then, the 51st time, experience an allergic reaction. Dr. Elliott Pearl, an allergy specialist with ENTAA Care, a seven-office practice in the Baltimore region, says allergic reaction can take many forms.

Children often have systemic reactions, Pearl says, but the chance of a second one is only about 15 percent. Adults, on the other hand, have a 60 percent chance of a second bad reaction. "Who you test and treat depends not only on the allergic reaction but also on the likelihood of whether they would be stung again," Pearl says. "For example, a person who works indoors might not be in as much danger as a landscaper or a BGE lineman or people who do a lot of hiking."

Fatal reactions are less likely in the young. People on certain blood pressure medications or with some coronary artery diseases are at higher risk.

But doctors say people should not panic. Golden recalled one patient, a lineman, who, after being stung, passed out, fell down and woke up a few hours later, got up and went home. "So your body is miraculous," he says.

If you are stung ...

* Take an over-the-counter antihistamine such as Benadryl and apply ice to counter itchiness and swelling.

* For shortness of breath or any problem breathing, see a doctor or visit the emergency room promptly.

* In case of multiple stings, visit the emergency room. (Before you panic, consider that the lethal dose of venom is about 500 bee stings for a child and 1,200 for an adult.)

* If you know you are allergic, head for the emergency room. If you carry an automatic injected prescription, take it first.

* Ask for help. Maryland law allows lifeguards, school bus drivers, and others trained under the Good Samaritan law to administer epinephrine for an allergic reaction.

If you don't want to be stung ...

* Stay away from yardwork -- yellow jackets build huge nests underground, accessible by a tiny hole in the ground. They don't like to be run over by your lawn mower. Hedge trimming, too, can be hazardous. Hornets build nests in trees or bushes, and wasps make paper-like nests in eaves of houses.

* Don't use your hand to push open an outdoor trash can, advises Baltimore allergist Elliott Pearl. "Those little critters around the trash are usually yellow jackets, and they are the most aggressive."

* Avoid drinking from a can or colored glass -- yellow jackets often lurk inside, and are apt to sting the mouth and throat.

* Insects are attracted by color and scent. Choose white or off-white clothing over florals, and avoid perfumes, colognes and other scents.

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