Insect stings

ASK THE EXPERT

May 15, 2008|By Holly Selby

It is the season of baseball games, picnics, backyard barbecues ... and all kinds of insects. If you've ever been stung by a bee or wasp, you know it's no fun at all. For many people, a sting can be a serious matter, says Dr. David Golden, associate professor of medicine at the Johns Hopkins University and chief of the allergy division at Franklin Square and Sinai hospitals.

What constitutes an allergic reaction to insect stings?

There are different kinds of allergic reactions: If you get stung and have pain and itching, that is normal. If you get a huge swelling that lasts a week, that is probably a local allergic reaction, and it isn't really dangerous unless you get stung in the throat.

But if you are stung and 10 minutes later, you break out in hives, you feel faint or your throat starts to swell, these are potentially life-threatening or even fatal reactions, and this is called a systemic reaction.

How many people will typically be allergic to insect stings?

About 3 percent of adults have had a systemic reaction to an insect sting sometime in their lives. Two to three times that many have had reactions that cause large swellings. If you have had a large swelling after getting a sting, there is a 5 percent chance that you will have a systemic reaction next time. If you have had a systemic reaction, there is a 50 percent chance it will happen again.

What kinds of insects are most likely to cause an allergic reaction?

Biting insects almost never cause systemic reactions. The really big deal in allergic reactions is stinging insects. Bees, including honey and bumble, don't really like to sting you, and if they do, they die. So mostly people who run around barefoot need to watch out for them.

The wasps, including yellow jackets, hornets and paper wasps, are the group responsible for almost all of the severe reactions that we see. The third group of stinging insects is the fire ants, and they are mostly in the southeast third of the country (Alabama, Mississippi and Texas) so they are not as relevant in Maryland.

What happens if you are allergic to an insect sting?

Systemic reactions or anaphylaxis are usually fairly quick, coming in 20 to 30 minutes after the sting. So if you get stung and don't have an allergic reaction in 30 minutes, you probably are not going to have one.

If someone does get stung and 10 minutes later feels like his throat is swelling and has trouble breathing or dizziness like he is going to pass out, then it is a potentially dangerous problem. This person could be breaking out in hives all over the body. Breaking out in hives is not yet an emergency, but it could turn out to be one.

When should you call a doctor?

If you are breaking out in hives, go to a doctor. If you are having any internal symptoms like throat swelling, then call 911. That could get real bad real fast.

If you have had an allergic reaction to a sting once before, should you be concerned about future stings?

A lot of people will have one reaction and think it was a fluke, but they ought to tell a doctor. If they have had any symptoms like hives or swelling of the throat, they can have them again.

People with bee sting allergies should be immunized so they don't have to worry about having a reaction. If you go to the ER with a reaction, they should give you an EpiPen or Twinject [auto-injectors that administers epinephrine], but ultimately, you should be immunized.

We have allergy tests and shots that can make it so you will never have this kind of reaction again.

How do you treat a sting?

Cleanse the area, remove the stinger if you can, and treat with ice. There is allergy medicine for the itching like Benadryl or Zyrtec (both have over-the-counter or generic forms).

Folk remedies such as toothpaste don't really work. Meat tenderizer theoretically works, but you'd have to keep it in your pocket, and most of us don't.

What if you have a large swelling?

If the swelling is prolonged, put ice on the area. You can also call the doctor for cortisone to help with the swelling and to get steroid pills in the first day if possible. But the swelling is not dangerous and will go away in five to 10 days without treatment.

What is the treatment for a systemic reaction?

The only antidote for a systemic reaction to anything from peanuts to bee stings is an injection of epinephrine (adrenaline). That is what comes in the EpiPens that severely allergic people carry with them. The EpiPens or Twinjects can save your life.

Do you have any tips about avoiding getting stung?

Ideally, if you have a bad allergy to insect stings then you would never drink or eat outdoors -- period. Food and drink attract stinging insects so picnics and garbage cans are off-limits and absolutely don't drink out of cans or through straws -- anything that you can't see inside of.

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