By Natalie Harding
Summertime in Vermont. It's a great time of year for getting together outdoors with family and friends, fixing up the house, catching up on yard work.
Unfortunately, it's also a great time of year for bugs that bite and sting, and they love to join the picnic.
Recently, there has been much attention given to the dangers of mosquito and tick bites, and that's important because diseases from these insects are becoming more common — think Lyme disease, and the occurrence of Zika virus when travelling to certain parts of the world.
But let's focus on stinging insects, particularly bees, hornets, and wasps.
While it's true that the great majority of people do not have any lasting or severe reaction to insect stings, for some people, it can be a deadly situation, perhaps worsening over time.
Most people experience a sharp and burning pain at the site of the sting, with redness and swelling around the sting, which can be alarming and quite painful. This will usually go away after a few hours. Some people get a larger local reaction, with redness that spreads out from the sting site and lasts for several days. Cold compresses, pain relievers, and antihistamines can help with these symptoms. These reactions are not necessarily signs of sting allergy.
Children are more likely to have a larger local reaction to a sting than adults. Men are more likely than women to become allergic to stings. Beekeepers and people who are stung numerous times, or receive multiple stings in a short time, are more likely to develop a sensitivity and possible allergy. This could include house painters, carpenters, or gardeners as well.
If your reaction gets worse every time you are stung or bitten, it is probably wise to speak to a medical provider about prevention and treatment, because occasionally, it is possible for someone to have a mild reaction to an insect sting one time, and when stung later, to have what is called an anaphylactic reaction.
The symptoms of anaphylaxis can vary, but generally a person will develop hives; severe itching; tingling in the mouth; swelling of the tongue, lips, or any part of the body away from the sting site; and/or difficulty breathing. Some may vomit, have belly cramps, or feel dizzy. When these symptoms occur, there is no time to wait. A person with an anaphylactic reaction can go into shock. This can be fatal.
Do you know what to do if you are with someone who goes into anaphylactic shock after being stung by a bee? Those with known anaphylactic triggers should plan how to avoid these dangers and should carry an epinephrine injector or two (often called an EpiPen) with them at all times. Hopefully they can administer it to themselves. What if they cannot? Do you know how to help?
In a pinch, when there is no other alternative, an antihistamine like Benadryl may buy you a little time, but truly it is no substitute for epinephrine, which must be administered as soon as possible during an anaphylactic reaction. A person who is having a hard time breathing will not likely be able to take Benadryl by mouth, so do not rely on this option as a back-up plan. If available, use the injector.
Epinephrine injectors are designed to be easy to use. These simple directions are provided by EpiPen (their website includes a how-to video): Flip open the cap and remove the injector from the tube. Hold the injector around the middle with the orange end down (remember the phrase, "blue to the sky, orange to the thigh").
Being careful to keep the orange part away from your fingers (that's where the needle is), remove the blue cap. Then smack the orange part of the injector against the upper thigh, hold it there for ten seconds, then remove it. The needle is strong enough to go through clothing, including heavy clothes like jeans.
After you remove the needle, rub the spot for 10-15 seconds, and immediately call 911 or head straight to the emergency room. This is important because sometimes the symptoms come back. Epinephrine injectors often come in a two-pack, and a second dose can be administered 10-15 minutes after the first.
If you have been prescribed an EpiPen, be sure your prescription is not out of date. The pharmacy can tell you about proper storage of the injector pack.
There are some contraindications for those who have cardiac issues and a few other illnesses, but if someone has an EpiPen, you should not hesitate to use it. An epinephrine injector should not be used in response to normal, non-allergic bee sting reactions, so it's important to know the difference.
All of us can be good citizens by increasing our awareness about anaphylaxis and by thinking about how we could help in case of an emergency. You can find good information on the American Academy of Allergy, Asthma, and Immunology's website, www.aaaai.org, or the Cleveland Clinic's website, www.clevelandclinicmeded.com.
Natalie Harding is a Physician's Assistant practicing at Grace Cottage Family Health in Townshend, VT. Natalie earned her Master of Physician Assistant Studies from Franklin Pierce College in New Hampshire. She worked in Greenfield, Mass., before joining Grace Cottage Hospital in 2014.