Life StoryApril/May 2008 Issue

Play it Safe When Reacting to Bee Stings

Rebecca Cunningham wasn’t overly concerned when her daughter, Sophy, was stung on the bottom of her bare foot by a yellow jacket. As an emergency room doctor at the University of Michigan Health Center, Cunningham tended to minimize most of the childhood scrapes that Sophie and her younger sibling, Ella, endured. Compared to what Cunningham saw at work every day, a bee sting was nothing. 

Allergic to Bees

She lifted her daughter onto a picnic table, calmly examined her foot, put some ice on the sting and comforted the whimpering little girl. 

That summer two years ago, Cunningham, her husband John, and their two young girls were camping with extended family in a remote spot in a national park in Michigan. Hiking into the woods miles away from city noise and the stress of high pressure jobs was something this family, which resides in Ann Arbor, loved to do. Sophy had been stung once before. This was no big deal.

After a minute or two, Sophy, then 5 ½ years old, said her foot felt okay and climbed down from her mother’s lap. But five minutes later, she was back complaining. 

“She said, ‘Mommy, my mouth feels funny,’” recalls Cunningham, who was pregnant with her third child, Alita, at the time. And then, “‘My tongue feels funny,’”

Cunningham noticed Sophy’s lips were swelling. She took a quick look inside the girl’s mouth to check if her tongue was enlarging. It was.

“A child this age doesn’t know what an allergic reaction is,” says Cunningham. “So when she said her mouth and tongue felt funny, I knew instantly she was having a reaction to the bee sting.”

Cunningham had only a simple first-aid kit with her. Luckily, it contained Benadryl which she quickly stuffed into her daughter’s mouth. They were in the middle of nowhere, at least ten minutes away from the nearest help, but because they were car-camping, their vehicle was close by.  With efficient speed, she and her husband threw the kids in the car and raced to the ranger’s station. On their way there, Sophy’s face began ballooning.

“Her ears swelled up so much that one of them actually cracked,” Cunningham says.

“Mommy, Mommy! I can’t breathe!” Sophy cried, her voice growing hoarse. She started coughing. Her stomach hurt. Her blood pressure was dropping.  
As they reached the ranger’s station, Cunningham jumped from the car and called out to the ranger her need for a first-aid pack and an ambulance. She tore apart the first- aid kit, searching for the auto-injector epinephrine, or EpiPen, that she hoped would bring her daughter out of anaphylactic shock. There was none.

“It was terrible!” says Cunningham. “It was a really long ten minutes waiting for that ambulance.”

Sophy was wheezing hard by the time the ambulance arrived but as soon as the paramedics injected her with epinephrine, she started coming around. On the 45-minute drive to the hospital, her other symptoms began to ease. In the hospital, she was given IV fluids and then released later that day.
But Cunningham knew her worry was far from over.

“We’re a really active family. We do a lot of back-country camping, hiking in for a mile or more with fairly young children. What were we going to do? How were we going to go anywhere without having to worry that Sophy might get stung and have another anaphylactic reaction?” she asked.  

The Buzz on Insect Stings
According the American Academy of Allergy, Asthma and Immunology (AAAAI), from 0.5 to 5 percent of Americans, up to 13 million people, are allergic to insect stings. Five types of insects are the culprits, all belonging to the Hymenoptera class—honey bees, hornets (white faced and yellow), yellow jackets, wasps and fire ants. In the Midwest, yellow jackets are the most common insect that people are allergic to. In the South, it’s fire ants.

The range of reactions from an insect sting can vary widely, from normal small redness and swelling to larger local reactions (like a swollen arm due to a sting on a fingertip) to systemic allergic reactions like life-threatening anaphylaxis. More than 50 deaths a year occur from stings, with up to a million hospital visits.

Fortunately, most allergies to bee venom antigens are treatable, says David Lang, M.D., head of allergy and immunology at The Cleveland Clinic Foundation. A skin or blood test is usually done to confirm which one of the five insect groups (or combination) a patient is allergic to.

Bee Allergies

Lang often recommends venom immunotherapy, also known as venom protein injections or allergy shots. ”Since you can’t hibernate indoors the rest of your life, venom injections are very effective in reducing the risk of potentially serious reactions in the future,” he says.

“Most people must be stung at least once before having an allergic reaction the second time around. You have to have that initial exposure that sensitizes you to the venom,” Lang says. “Unfortunately, most patients learn the hard way they are allergic the second time around.”       

Bee Tested
When Sophy was tested, it was determined that she was allergic to yellow jackets and wasps. The course of treatment recommended by the family’s pediatric allergist was venom immunotherapy, starting with weekly shots of minute amounts of venom, increasing the amount slightly over time to build up tolerance. Then monthly shots, for a total of 3 to 5 years of treatment.

“Getting her tested was sort of torture for her,” Cunningham says. The treatment wasn’t fun, either. “Most children aren’t excited about getting shots, let alone getting one every week.”

Sophy got her treatment shots on Fridays. The whole family went with her to show support.

“Although she dreaded them and hated it, she was a real trooper. We had tons of discussions about it,” Cunningham says. “But she has quite strong memories about getting tossed in the back of the ambulance and she didn’t want to go through that again.”

For the most part, Sophy tolerated the weekly shots well. Occasionally, she would have an allergic response and require epinephrine in the doctor’s office but she never had a full-blown reaction like the original episode. Now she goes for shots once a month and will continue to do so for another three years or so.

Lang says immunotherapy is known to decrease the risk of anaphylaxis by 90 percent. The AAAAI rates effectiveness at up to 97 percent.

“We’re really happy that this is one of the more fixable types of things,” Cunningham says.

Yet even with these odds, the AAAAI recommends that allergic patients protect themselves from risk, wear a medical ID bracelet and keep epinephrine on hand at all times.

Back to Nature
In the two years since Sophy’s allergic reaction to the yellow jacket sting, Cunningham often thinks back on what could have happened to her daughter had she not been a doctor and known what to do.
“What if I hadn’t been there? What if it had been her grandmother or somebody else and they had waited another 15 minutes before they brought her to the ranger’s station?” she wonders. “Sophy could have really had a problem.”

Cunningham admits that she’s still trying to find a balance between encouraging her daughter to be cautious while trying not to scare her or limit her too much.

“We’re outside a lot and Sophy is an active girl. She likes to run around and do all sorts of things and we try not to terrify her,” Cunningham says. “But she has to understand that if it’s summertime and she’s running around in the grass, she must wear shoes. Things like that. Normal precautions.” 

There have been other changes. The family always carries an EpiPen everywhere they go and Cunningham has instructed all of Sophy’s teachers, babysitters and summer camp counselors how and when to use it. 

As for hiking, camping, backpacking and eating outdoors, Cunningham says they’re still doing all those things. Only now, because Sophy’s gone through the allergy shot regimen, “we feel a whole lot better about doing it.”

Bee Aware
Once an allergy is confirmed, manage it by following these steps.  

Be Careful  Avoid bees, wasps and hornets as much as possible. Stay away from places where insects nest and gather. This isn’t always easy. Case in point: David Lang, M.D., of The Cleveland Clinic Foundation recently had a patient who opened a shoebox in the back of her closet and was stung by a wasp in the middle of the winter. “You have to expect the unexpected,” Lang says. 
Be Smart  Use common sense when you’re outdoors. Cover arms and legs during outdoor activities, such as gardening. Avoid baggy clothing where insects can be trapped. Don’t go outside smelling like a flower or wearing bright colors or large, floral patterns. Wear shoes. Be careful when eating and drinking outside. Yellow jackets love sodas and have been known to climb inside open cans and bottles. 

Be Pro-Active  Wear an emergency ID bracelet. Always carry an EpiPen. If you must use it, seek emergency medical treatment immediately as secondary reactions can occur. LW

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