INTRODUCTIONAllergic reactions to bee and wasp stings have been known since ancient times. For example, the hieroglyphs in the tomb of Pharaoh Menes of Egypt indicate that this king died as a result of an insect sting. Even today, people still die from bee or wasp stings. During a sting, the insect releases venom into the victim's skin. In non-allergic individuals, a bump develops around the sting site that becomes red and can be intensely itchy. This bump usually disappears after a few days.THE ALLERGIC REACTIONA small portion of the population reacts exceptionally severely to a bee or wasp sting. Such a severe reaction usually indicates an allergy to bee or wasp venom. Such a reaction can only occur if the person has previously come into contact with the insect venom. With the first sting (which is often forgotten), a patient usually does not react severely, although the allergy can fully develop. This can lead to life-threatening situations with the next sting. This can manifest as red bumps all over the body—including on the palms of the hands and soles of the feet—accompanied by severe itching. In addition, the eyes and lips, among other things, may swell. If swelling occurs in the neck area (often invisible), the patient may have difficulty speaking and swallowing, become hoarse, and breathing may be impaired. Breathing problems can also occur due to a narrowing of the airways in the lungs, as occurs in asthma. This manifests as shortness of breath, wheezing, and a tight feeling in the chest. In some patients, the gastrointestinal tract is also involved in the reaction, and nausea, vomiting, diarrhea, abdominal cramps, and bowel movements may occur. Sometimes, urine is also released spontaneously. In the most severe cases, blood pressure can drop sharply and cardiac arrhythmias may occur, sometimes followed by loss of consciousness. These reactions usually occur within fifteen minutes of a sting.EMERGENCY TREATMENT FOR SEVERE REACTIONS TO AN INSECT STINGA patient experiencing any of the symptoms described above should see the nearest doctor as soon as possible. This doctor can administer emergency treatment consisting of one or more injections. Hospitalization is even a possibility. Afterward, the patient should contact their general practitioner. They may prescribe an emergency kit so that the patient can administer emergency treatment themselves the next time they are stung.
The kit includes an automatic syringe that, when pressed against the thigh, automatically releases the needle and delivers the injection fluid. Fortunately, there is now a treatment that almost completely protects patients against reactions after an insect sting, called hyposensitization therapy. The general practitioner will refer the patient to a specialist for this. This is usually an allergist, dermatologist, internist, pediatrician, ear, nose, and throat specialist, or pulmonologist.DETERMINATION OF INSECT VENOM ALLERGYThe specialist will diagnose an insect venom allergy through a consultation, skin test, and blood test, and will initiate treatment. During the skin test, small amounts of purified bee and wasp venom in increasing concentrations are injected into the skin using a small needle. The skin reaction also allows the specialist to determine the type of venom to which the individual is allergic. The species of insect can also be determined by analyzing the blood sample. Some patients have a significantly increased risk of developing life-threatening reactions after an insect sting. For these patients, the specialist will recommend a treatment that typically reduces the symptoms after an insect sting to those of a non-allergic person. This treatment is called a hyposensitization treatment.TREATMENT OF ALLERGY BY HYPOSENSITIZATIONThe best method for successfully treating a patient with a bee or wasp venom allergy is hyposensitization treatment. This treatment permanently desensitizes the patient to the insect venom. The injection treatment consists of an initial phase and a maintenance phase. During the initial phase, the treating specialist administers increasing concentrations of purified insect venom to the patient. The highest dose achieved corresponds to the amount of venom necessary for adequate protection against future insect stings. The phase following the initial phase is called the maintenance phase. In this phase, the patient receives the highest dose every 4 to 6 weeks. From the beginning of the maintenance phase, the patient is fully protected against the venom and no longer needs to carry the life-saving syringe. Until this point, the patient can take additional precautions listed below.AVOID INSECTS/PREVENT INSECT STINGSIt is important that patients with a bee or wasp venom allergy avoid these insects as much as possible to prevent being stung. The following measures can help:
Avoid flowering flowers or overripe (fallen) fruit, and be careful when picking fruit or flowers.
When eating outdoors (picnics), do not leave sweets or meat (leftovers) lying around, and use insect repellent cream or spray before eating.
Avoid trash cans and garbage bins.
Avoid areas where animals are fed, as scattered food scraps attract bees and wasps.
Do not move thick old branches or tree stumps, as wasps can nest there.
Caution is advised when gardening and cycling! Cover your body as much as possible (for example, with a hat, gloves, a long-sleeved shirt, and long pants).
Avoid using perfume, hairspray, strongly scented soap, sunscreen, aftershave, or body sprays.
Wear tight-fitting clothing and avoid black fabrics and colorful floral patterns. White, green, and light brown fabrics are preferable.
Be especially careful when exercising or playing outdoors, as perspiration attracts stinging insects.
Never walk barefoot outdoors. Bees love clover, and many wasps live in the ground. Also, don't wear open shoes.
Avoid quick movements. If a bee or wasp is nearby, don't rush to attack it.
Keep your bedroom windows closed during the day or install a screen.
Have insect nests removed by a professional exterminator.
If you are stung despite all precautions, remove the stinger as soon as possible, as venom is "pumped" from the venom sac even without the insect (especially in the case of bees). Scratch the stinger with your fingernail or a knife. Don't pull the stinger out of the skin between two fingers, as this will further squeeze the venom sac.
Always carry your emergency kit with you if you are not yet being treated with a hyposensitization treatment or have not yet reached a maintenance dose. Inform your colleagues, family, and friends about your insect venom allergy and show them the automatic syringe. Explain to them how to use it in an emergency. If you are stung, you can initially wait and see, as a reaction doesn't always occur (this happens in about half of all cases). Keep your emergency kit handy and keep your body as cool as possible, for example, by seeking shade. Reactions that occur on the skin around the sting site are not important, but reactions that occur elsewhere in the body are. In the latter case, you must be very vigilant. If you feel you are losing consciousness or cannot breathe (properly), or if you have any doubts about your recovery, you should quickly use the automatic syringe. Afterward, you should always consult a doctor as soon as possible so that definitive medical treatment can be initiated. |
