bee stings

[b.lambert]

got stung on wrist through my glove whilst inspecting the hive no immediate reaction but by 10.00pm my forearm was up like a balloon and very itchy, next day where the sting was a very red blistery patch done all the usual bicarbonate of soda etc and have never had a reaction to stings was just wondering if the type of pollen the bees bring in could cause such a reaction? Any thoughts? Meanwhile the bees are doing great 8 sealed brood and larvae, they have drawn the upper brood chamber with only two frames to go also put in honey super in as a drone trap for varroa in bottom brood. Its been lovely weather for the bees and they sure have been working hard.

[Calum]

Hi,
sounds like someone in your area was spraying something fairly nasty. I have had multiple stings on the same day and some swell up anthers don't react at all. Worst day was about 25 stings. with quite a few on my face - without swelling, but one on my arm was like a balloon!
What pollen are you allergic to? I only react to grass pollen so it is unlikely that caused my swelling.

[Neils]

On the subject of bee stings, I'd read an account on another forum of a beekeeper who had a bad reaction to a number of beestings, what they initially thought was an allergic reaction they now seem to think that it might be a result of having taking Ibuprofen shortly before the inspection. My google-fu is failing me as the only mention I can find at the moment is on Dave Cushman's site. Does anyone happen to know of any more detailed information as it was a new one to me when I heard about it and casual conversation with more experienced guys seems to suggest it's not common knowledge, indeed most websites detailing dealing with beestings specifically suggest taking iboprofen to lessen the pain/swelling.

[Jon]

Ibuprofen is the only headache tablet/anti-inflammatory I ever take. I never react to bee stings with or without it. I would be very surprised to hear that it can cause a reaction to a bee sting.

[Neils]

As I can see where this stands a chance of heading, can I just quickly make a point that the guy took a number of stings, I believe it was around 10-15, so I'm not suggesting for a second that a single sting after taking an ibuprofen tablet is going to send beekeepers everywhere to hospital in the back of an ambulance.

What little I've managed to read about it suggests that it doesn't so much cause the reaction as lower your tolerance to the venom and, in the case of the guy mentioned, who took a lot of stings very quickly, caused what initially looked like a pretty severe allergic reaction.

[edit] Found mention of a study on a New Zealand Medical site
http://www.medsafe.govt.nz/profs/PUarticles/bee.htm


Two published1 cases more clearly implicate a non-steroidal anti-inflammatory drug (NSAID) with sensitisation to insect stings. Two individuals who had previously been exposed to bee or wasp stings with no or only local effect developed a severe anaphylactoid reaction within minutes of being stung. One patient was taking ibuprofen and the other diclofenac

Bernard AA, Kersley JB. Sensitivity to insect stings in patients taking anti-inflammatory drugs. Brit Med J 1986;292:378-9. is the study

[edit edit] Not as informative as I'd hoped but a useful summary I guess.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1339355/pdf/bmjcred00220-0022b.pdf

[GRIZZLY]

The forum with the details of bad reactions to bee stings is on the "BEEKEEPING FORUM".On this forum is a download from the British Medical Journal which conclusively shows that non steroidal anti inflamitory drugs Ibuprofin and Diclophenac (Voltarol) can cause a tempory loss of immunity to bee stings causing anaphalatic shock.Immunity is regained if these drugs are not taken or when they cease to be in the system before "playing" with the bees.Extract shown below :-
378 BRITISH MEDICAL JOURNAL VOLUME 292 8 FEBRUARY 1986
Sensitivity to insect stings in patients
taking anti-inflammatory drugs
Bee sting are known to cause various reactions in different patients as well as
on different occasions in the same patient. Anaphylactic reactions have been
described in people who had previously developed no reaction to bee stings,
and apparent spontaneous cure of their sen=sitivity has been reported.' We
report two cases of sensitivity to bee stings occurring while patients were
taking anti-inflammatory drugs.
Case reports
Case I-A 66 year old beekeeper had developed apparent immunity to bee
stings over six years. She was prescribed diclofenac 50 mg three times daily for
severe bilateral hip osteoarthrosis, not taking other drugs andnever having taken
steroids. Some. months after -starting the anti-inflammatory treatment, however,
she was stung on the wrists while attending her beehives and within 15
minutes developed an aarming reaction with palpitations, a rash over the trunk
and limbs, and swelling ofthe mouth and tongue causing dyspnoea. This settled
spontaneously within a few hours. The following day she did not take any drugs
but again sustained several bee sings, and although a similar reaction developed,
it was much mildern The next day-48 hours after her last dose of the
diclofenac-fluther bee stings had no effect. She took no more anti-inflammatory
drugs and had no further reactions.
Case 2-The 48 year old wife of a beekeeper had previously had only local
reactions towasp stings. She had taken ibuprofen for osteoarthritis of the spine
for five mhonths before she was stung by a wasp. Within two minutes generalised
swelling, red itchy rash, palpitations, and shortness of breath developed, with a
senseofimpendingdoom. Tr¢atmentinhospitalfor24hoursincluded parenteral
adrenaline, antihistamine, and hydrocortisone. Another waspstnmg her two days
Later, after she had stopped takting ibuprofen, and a less severe reaction
developed, possibly helped by speedier transfer to-hospital.- Further antiBRITISH
MEDICAL JOURNAL VOLUME 292 8 FEBRUARY 1986 379
inflammatory drugs were taken and she began a course of desensitisation to wasp
venom.
Comment
Immunity to bee stings is well known among beekeepers, indeed it
appears that people get temporary relief from the pain of arthritis if they
sustain several bee stings. Allergy to insect stings is a local or system type I
immediate hypersensitivity reaction mediated by IgE. The effect of allergy
to anti-inflammatory drugs may not be the same in all subjects, as has been
shown in asthmatic patients sensitive to aspirin.2 Treatment with antiinflammatory
drugs is widespread and may be overlooked in victims of bee
stings as a possible complicating factor.
We have found no previous report saying that diclofenac, ibuprofen, or
other non-steroidal anti-inflammatory drugs can reversibly modify the
immune response. Though changes in specific tests have been shown in
animal and in vitro experiments," no noticeable general immunosupression
has been reported in a clinical situation.
We think that all beekeepers should be warned of this possible hazard if
prescribed non-steroidal anti-inflammatory drugs.
1 EwanPW. Allergytoinsectstings: areview.7R SocMed 1985;78:234-9.
2 Asad SL, Kemeny DM, Youlten LJF, Frankland AW, Lessof MH. Effect of aspirin in "aspirin
sensitive" patients. BrMedJ 1984;288:745-8.
3 Aleksandrowa GM, Roshkowa WN, Borissowa LN. Study comparing immunotrophic effects of
diclofenac sodium, indomethacin and sodium salicylate. Farmakol Toksikol 1981;44:450-3.
4 Lang G, Phumb N, Kraus H. Inflence ofdiclofenac on PHA-4ymphocyte: stimulation in RA paients
and controls. Bethesda, Maryland: International League against Rheumatism, 1977:256.
(Abstracts from XIV International congress of rheumatology.)
5 Wildfeuer A. Effect of anti-rheumatic drugs on the release of lysosomal enzymes from human
leukocytes. Z Rhewmatol 1984;43:23-6.
(Accepted 30 October 1985)
Department ofOrthopaedic Surgery, East Birmingham Hospital, Birmingham
B9 5ST

[gavin]

'may be overlooked as a possible complicating factor' seems right, but people should keep this in context.

One case: anaphylaxis then OK after stopping taking the NSAID. Another case: wasn't so bad the second time but got to hospital quicker. This doesn't add up to very much.

It has been known for a long time that allergies can come and go with no particular reason. The link with NSAIDs hasn't been made strongly, and it is pretty clear that bee sting allergy happens in people who are not taking NSAIDs. I was one. I'm pretty sure that it can also spontaneously disappear without NSAIDs being involved.

I think that I've related my anaphylaxis experiences on the other (BBKA) south of the border forum and maybe we should discuss it here too. The short story is that this is a big issue for beekeepers and their families, and beginners ought to be aware of this from the outset. Particularly be aware that it might happen to you, and know what to do if it does.

G.

[gavin]

Back to B's original post. You just have a normal reaction there. Sometimes stings are worse, sometimes not. I don't know what causes that but I doubt that the pollen they've been eating or even pesticides in the area have much to do with the strength of the reaction. In general, you should find that your reaction declines as your body adapts, but it is best to avoid stings if possible.

I don't think that bicarbonate of soda helps. If you have a reaction that appears elsewhere, that may be an allergy. Red lumps, numbing sensation, swelling, dizzy, then get help.

[Neils]

'may be overlooked as a possible complicating factor' seems right, but people should keep this in context.

One case: anaphylaxis then OK after stopping taking the NSAID. Another case: wasn't so bad the second time but got to hospital quicker. This doesn't add up to very much.

It has been known for a long time that allergies can come and go with no particular reason. The link with NSAIDs hasn't been made strongly, and it is pretty clear that bee sting allergy happens in people who are not taking NSAIDs. I was one. I'm pretty sure that it can also spontaneously disappear without NSAIDs being involved.

I think that I've related my anaphylaxis experiences on the other (BBKA) south of the border forum and maybe we should discuss it here too. The short story is that this is a big issue for beekeepers and their families, and beginners ought to be aware of this from the outset. Particularly be aware that it might happen to you, and know what to do if it does.

G.

I agree having actually had a chance to read what was being referred to. Again I want to re-iterate that I wasn't trying to suggest that taking a nurofen was going to lead to beekeepers around the country being rushed to hospital after taking a sting. I also hadn't realised until I found it that the study was dated 1986 and I'd have expected a lot more in the last 14 years if there was a major cause for concern than two cited cases, though I do still think that it's perhaps something to bear in mind. Part of why it took me a while to track stuff down was that searches throw up 10 pages of websites advising you to take an ibuprofen tablet after being stung.

[Stromnessbees]

I had my First Aid training recently (organised by Voluntary Action Orkney and the Red Cross), with a special half hour on anaphylactic shock treatment and the use of the epipen.
It made me confident that I would be able to deal with such a situation and I can only recommend it.

Our local GP also offered to give a short training session on dealing with anaphylactic shock, and as we are about to set up our teaching apiary I hope that a few of our association members are going to do it.

A shame though, that those epipens are so expensive. Maybe we could do a bulk order through SBA?
Doris

[gavin]

Are Epipens not prescription only?

G.

[Stromnessbees]

Gavin, yes they are, you are right. - This would make bulk orders very difficult or impossible.

We'll get a prescription from our GP for the teaching apiary. The epipen can be kept on site in a First Aid box.

Doris

[Trikin Dave]

I used to show the reaction described in the original posting, an enormous swelling that itched like mad for a several days. I found that the best cure was two piriton tablets immediately (doctor confirmed that the only side effect would be to make me sleepy) and covering the wound with an ice pack BEFORE the swelling started.
Then the plot thickened, a single sting sent me into anaphylactic shock but I managed to take the piriton before things got out of hand. There then appeared a letter in the Scottish Beekeeper warning of a connection with NSAIDs which my doctor confirmed as a known side effect. As with all side effects, some people get them, others don't, but there is not normally a sudden change.
I'm afraid things have now got much worse in that I can't tolerate a single sting at any time with out taking an antidote: piriton seems to work for me and I also have epipens on prescription. The thing that disturbs me is that I am not allowed to save someone's life by "prescribing" drugs even in an emergency. That includes piriton.
As a footnote, I don't think the bees' forage is relevant.
Cheers,
Dave

[Rosie]

The thing that disturbs me is that I am not allowed to save someone's life by "prescribing" drugs even in an emergency. That includes piriton.

I think that's particularly true for epipens. I wonder if Doris managed to get her epipen for the apiary. I have been told by more than one GP that no doctor would be allowed to prescribe one for such a situation and anyone administering one without the right qualifications would be committing a criminal act. I have also asked if it could be possible for a first aider to be given training specifically for administering epipens but was told that no such limited qualification exists.

Rosie

[EmsE]

I have also asked if it could be possible for a first aider to be given training specifically for administering epipens but was told that no such limited qualification exists.

Rosie
My 3yr old boy has a fish allergy & the GP prescribed an epipen for him and advised me to see the nurse the following week to be shown how to use it. I have to say that reading the instructions that came with it was more useful than the demonstration. The nursery advised that they have had their training to use one which I can only assume was through the health board too. I hope it was better than mine.

[Rosie]

The nursery advised that they have had their training to use one which I can only assume was through the health board too. I hope it was better than mine.

I would be surprised if the nursery staff were permitted to administer an epipen to someone that had not been prescribed it by a qualified medic.

Rosie

[EmsE]

Hi Rosie,

You're right. They have to received the training and then get approval from the insurance company before the epipen can be taken in. The epipen also has to have the label demonstrating that it has been prescribed/dispensed for the individual concerned plus the consent form signed by the parents. Taking all this into account, it would probably be impossible for a apiary to hold one.

[Trikin Dave]

One problem with Epipens is that if you hold it the wrong way, it's easy to inject your thumb. It doesn't sound too serious until you're told that the device works by constricting the blood vessels so that in the confined volume of your thumb the circulation is cut off. The result is that you lose your thumb!
Cheers,
Dave.