Monday Medical: Bee sting allergy — to hike or not to hike
Outdoor recreation is one of the biggest draws to living in Steamboat Springs, but for those with a history of bee sting allergy, it can be more frightening than enjoyable, at times. The risk of a repeat reaction can be as high as 60 percent, a fact that keeps many outdoor enthusiasts cautious and afraid.
Bee stings can cause a variety of reactions. Most stings will cause redness, pain and swelling at the site of the sting. This local reaction is expected, and while it is unpleasant, no treatment is needed, as it will resolve on its own.
A systemic reaction, on the other hand, can be fatal. Systemic reactions can range from mild to life threatening and include skin flushing, hives, itching and swelling of the eyes, lips or throat. Severe reactions can cause problems with breathing, swelling of the throat and collapse. These severe bee-sting reactions are the leading cause of fatal anaphylaxis.
For individuals with a prior systemic reaction, it is important to have a dual pack of epinephrine auto-injectors — or epi-pens, as they are most commonly known — on-hand in case of another sting. Epinephrine can be life-saving in the event of a severe reaction and should be used immediately after the onset of a reaction. The effect of the epinephrine dose in the pen only lasts five to eight minutes, so having two pens on-hand is always recommended. It is also important to call 911 for further medical assistance.
Fortunately, there is another option available to those with a history of a systemic reaction — venom immunotherapy, or VIT. Venom immunotherapy treatment starts with weekly injections of bee venom. Each week, the dose increases, to the point at which the dose given surpasses the amount received from a live sting. This higher dose causes the immune system to develop a relative immunity to the stinging insect. The build-up phase takes approximately three to five months of weekly shots, at which time injection treatments are lessened to monthly. These monthly injections are referred to as maintenance. The total time on VIT is generally five years, though some with a history of severe reactions or frequent exposure to stinging insects may choose to stay on the shots indefinitely.
Venom immunotherapy is the most effective form of immunotherapy in use. It can reduce the risk of a repeat reaction from 30 to 60 percent to less than 5 percent. Protection from a repeat sting is seen in most patients within one week of reaching a maintenance dose, at which time they can more safely return to the outdoors.
If you have a history of a large local or systemic reaction to a bee sting, it is important to identify which particular type of insect caused your sting. This allows for more careful awareness of your environment and avoidance of places these insects typically inhabit. Skin testing is preferred over lab testing due to its higher sensitivity. Testing includes honeybee, wasp, yellow jacket, white-faced hornet and yellow-faced hornet.
To be a candidate for VIT, you need to have both positive testing and a personal history of a severe reaction. A positive test alone, even with a family history of bee sting allergy, is not enough to predict a future reaction. For this reason, testing is only recommended for those that have experienced a large local or systemic reaction to a sting. Keep in mind that it is important to wait four to six weeks after a sting to be tested, as testing can be falsely negative if performed too soon after a sting.
Interestingly, children who react to bee stings with symptoms limited to the skin (hives alone, with no breathing problems or swelling of the mouth or throat) have only a 10 percent chance of a future systemic reaction. Those reactions are most often less severe. In these children, observation without venom immunotherapy is recommended while keeping an epi-pen on hand for safety.
If you have a history of a systemic reaction to a stinging insect and wish to return to the great outdoors with improved safety and confidence, discuss venom immunotherapy with your doctor to see if it may be helpful for you.
Kristen Fahrner, M.D., of Northwest Colorado Ear, Nose, Throat & Facial Plastic Surgery in Steamboat Springs, is a board-certified otolaryngologist and a member of the American Academy of Otolaryngic Allergy.
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