Systemic Reactions

The truth is, we all naturally jump back when we see a bee. But, some people have greater reason to do so than others. A bee sting could kill them.

"People react to bee stings in three different ways," says Richard Wyatt, MD, asthma and allergic diseases specialist at Park Nicollet Clinic. "People who experience normal reactions develop a welt, about the size of a silver dollar. It's red and painful, but generally goes away within 24 hours."

A second group responds with dramatic swelling - a large, local reaction about 10 inches in diameter. The affected area is painful, irritated and sometimes takes days to heal. "We often have to reassure people that these are not the most serious reactions - and they're not deadly," Dr. Wyatt explains. "We may treat some patients with oral steroids, but that's all."

A third group experiences a systemic response. This fast-acting reaction is the most severe and affects the entire body. For example, even though a person is stung on the hand, he or she may experience any of the following symptoms:

hives or intense itching and swelling anywhere on the body
wheezing or shortness of breath
swelling of the throat or difficulty swallowing
a sudden drop in blood pressure, shock or even death

Immunotherapy saves lives

"When people experience a severe systemic reaction to a bee sting, the next time they are stung could be fatal," Dr. Wyatt explains. "This risk increases with age and depends on a person"s overall health. To avoid this, we prescribe immunotherapy, which has a 95 percent chance of preventing another systemic reaction if they are stung again."

In the United States, as many as 40 to 50 people die each year from allergic reactions to bee stings. Immunotherapy helps people develop immunity to the venom that triggers this reaction. In Minnesota, people can be allergic to any of five insects: wasps, yellowjackets, white-faced hornets, yellow hornets and honey bees. People receive skin tests to determine which ones affect them. During the first five months of immunotherapy, people receive weekly shots containing small amounts of venom from the insects that cause their reaction. This repeated exposure helps them develop immunity to these allergens.

Beginning with the sixth month, patients receive maintenance shots once a month. Eventually, they may go as long as six to eight weeks between injections. The entire process can last three to five years, although some people may continue indefinitely. "Although it's time-consuming, people are glad to do it because they know it can save their life," Dr. Wyatt says.

People with less severe systemic reactions are taught to use an epinephrine auto-injector. These self-injecting syringes administer epinephrine, an adrenaline that helps people recover from respiratory problems, throat swelling or a drop in blood pressure. After using it, they need to call 911 or immediately go to a hospital emergency room.

Who's at risk?

"Bee allergies seem to affect all people equally. It's not just people with other allergies who are at risk - everybody is," Dr. Wyatt says. "In fact, some people with no other allergies or a family history of allergies may have a problem with bees."

Of course, it's important to do all you can to avoid attracting bees. "Don't wear cologne or bright, flowery clothing. Wear shoes to prevent getting stung on your feet. And, be sure to avoid standing near garbage cans when you're outside," Dr. Wyatt says.