Rusty English had been stung by a bee twice before, once on his pinkie finger and once behind the ear. Like most kids, he quickly bounced back from the stings.
The third time he wasn't so lucky.
"I was walking around barefoot," said Rusty, 12, of the incident four years ago. "I think I fell down right where a flower was, and probably I fell right on top of a bee."
Though he was stung on the foot, it was his neck that started to swell. He was having an allergic reaction to the bee sting.
For those with severe allergies, venom from a bee sting can close the airway and make breathing difficult. In the most serious cases, people can go into anaphylactic shock, which can, in rare cases, lead to death.
It is common wisdom in the medical community that children outgrow their allergies to insect stings. But new research suggests that about one in five people can still have allergic reactions three decades after a first severe incident.
Question of immunity
For those whose allergies persist, the study found that a series of allergy shots during childhood can provide protection from a severe allergic reaction at least 20 years later.
"No one's ever really determined whether that immunity stays with them," said Dr. David Golden, an allergist at Johns Hopkins Asthma and Allergy Center and lead author of the study, which appeared in the Aug. 12 issue of the New England Journal of Medicine.
Golden and his colleagues surveyed 512 adults who were diagnosed with bee sting allergies as children between 1978 and 1985. Then researchers looked at how many of those adults experienced serious allergic reactions to bee stings between 1987 and 1999.
Children who initially received allergy shots suffered from a moderate or severe allergic reaction from subsequent bee stings only 3 percent of the time. Patients who did not take the allergy shots had a 17 percent chance of having an allergic reaction.
Golden said one of the limitations of his study is that people who did not have the allergy shots or did not have bad allergic reactions may not have responded to the survey. So researchers could have slightly overestimated - or underestimated - the reaction rate, said Golden, adding that he did not think the results were skewed by these factors.
Because many doctors and parents mistakenly believe that most children outgrow their severe reactions to bee stings, they consider allergy shots unnecessary, Dr. Rebecca Gruchalla, an allergist at the University of Texas Southwestern Medical Center, wrote in an accompanying editorial.
Some allergists said children with mild allergic skin reactions probably don't need to get allergy shots. They are more likely to outgrow the allergy than are children who experience severe reactions.
Children with internal reactions, such as throat swelling, dizziness or nausea, should consider venom treatment, allergists said.
Shots or not?
If people with severe allergies don't get allergy shots, they should carry the EpiPen, an emergency dose of injectable adrenaline, for the rest of their lives, said Dr. Wilma Light, an allergist at Latrobe Area Hospital in Latrobe, Pa.
To build up patients' immunity, the allergy shots - made from insect venom - provide increasingly strong doses over time. The therapy typically lasts three to five years, according to the American Academy of Allergy, Asthma and Immunology.
For two years, Rusty, who lives in Joppa, has been on a regimen of booster shots to prevent another allergic reaction. He has about two more years of immunizations to go.
Rusty attends Boy Scout camp every year and plays soccer in the fall, said his mother, Mary. His parents decided to have him take allergy shots just in case adults weren't around when he got stung by a bee.
"He's very brave," said Mary English.