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For Patients & Families:
Bee Stings
Bee stings are one of the unfortunate side effects of beautiful, warm weather and flowering greenery. Wanda Phipatanakul, M.D., M.S., attending physician in Pediatric Allergy and Immunology at Children's Hospital Boston, took some time to talk about bee stings, from the minor to the severe.
How will a non-allergic person react to a bee sting?
For most people, bee stings are a painful annoyance that passes with some local swelling, minor pain and redness that disappears within a few hours.
How do you treat a minor bee sting?
For normal reactions, a cold compress and an aspirin or acetaminophen does the trick, and you'll be back out enjoying the sun.
How common are bee sting allergies?
About two million people in the United States are allergic to bee stings, and three percent of children who are stung will experience systemic allergic reactions.
How would a person who is allergic to bee stings react?
A systemic allergic reaction produces symptoms all over the body such as hives, itching, swelling, low blood pressure, difficulty breathing, and occasionally anaphylactic shock.
What is anaphylactic shock?
Anaphylactic shock is the most severe systemic allergic reaction and can happen as a result of many allergies. It rarely happens the first time you are stung, but upon subsequent stings the body will sometimes overreact to the bee venom. The result is painful hives and swelling over all portions of the body. This leads to blocked airways and sudden decrease in blood pressure. If not treated, it is potentially fatal.
How common is anaphylactic shock?
Only about one percent of bee stings result in anaphylactic shock, with it more likely to happen in people over the age of 25. This is because the more an allergic person is stung, the more severe the reactions get. Children, who likely have only been stung one or two times, will rarely experience such extreme reactions.
Who is at risk for dying from anaphylactic shock?
The 50 deaths per year from bee stings are generally in people aged 40 and older, many of whom have pre-existing heart conditions.
How do I know if my child is allergic?
Allergies are generally hereditary, so an allergic parent should be more cautious with her child, although children will often outgrow their allergy. If a severe reaction occurs, an allergist should be seen as soon as possible. Future stings could result in reactions that are up to 60 percent worse than the first allergic reaction.
How does one test for a bee sting allergy?
There are two types of tests and, unfortunately, neither of them is extremely reliable.

A blood test, called the RAST test, is the simplest test, but has about 20 percent false-negative, false-positive results.

The other, more sensitive, test is a scratch test on the skin that is performed with purified, freeze-dried venom. This is done to test for which types of insects the patient is allergic to. It can alert the patient and doctor to the severity of the allergy, while a blood test will only point to the fact that an allergy exists. Luckily, only about 20 percent of patients with positive skin test results will later experience severe allergic reactions.

Should I just test my child to be on the safe side, even if he hasn't had a reaction to a sting?
Testing for bee sting allergies before a serious reaction has occurred is unnecessary, as it is often a lengthy process and so few people are actually allergic. One should wait until a systemic reaction has occurred before worrying about allergies. The first allergic reaction is rarely that bad, but once again, see an allergist if a reaction spreads beyond the sting site.
How do people with bee sting allergies prevent severe reactions?
If a person is allergic, there are several steps he can take to protect himself. The patient should always carry a bee sting kit that includes a bronchodilator epinephrine shot or inhaler, which will dilate the airways and allow the person to breathe. He should also wear a medical alert bracelet or necklace. The most extreme option is venom immunotherapy, wherein the patient receives weekly shots of increasing amounts of bee venom to build up tolerance. It can reduce the chance of future severe reactions from 60 percent to about five percent.
Are there ways to avoid stings in general?
Yes. Avoiding brightly colored and flower print clothing will help keep bees away, as will avoiding fragrances or cosmetics with floral scents. Always be careful with food and sweet drinks such as soda. Bees will often fly into the can and sting the drinker when he takes a sip. If you are going into a field where there will likely be bees, wear long pants and shoes that cover your whole foot. And if there are bees around or on you, don't run. Standing still will keep the bees calm and, most likely, they will fly away without causing harm.
Source: Wanda Phipatanakul, M.D., M.S., attending physician in Pediatric Allergy and Immunology at Children's Hospital Boston.

Please keep in mind that the text provided is for informational purposes only and is not a substitute for professional medical advice, examination, diagnosis or treatment. Always seek the advice of your physician or other qualified health professional before starting any new treatment or making any changes to existing treatment.

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