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The Stinging Truth
The Stinging Truth What we are talking about are the insects that sting, namely the wasp, yellow jacket, hornet, bee, and fire ant.

Despite what you may have heard, not everyone is allergic to insect stings. But, if you are, you may be in danger if the stings are not managed properly. Every year, thousands of us are stung by insects and suffer the typical symptoms of local pain, redness, swelling and some itching at the sting site. However, those who are allergic to insects may suffer life-threatening reactions (anaphylaxis) if not treated properly.

We are not talking about insect “bites” from mosquitoes, gnats, bed bugs, and the like. These are certainly nuisances but will not lead to a life-threatening emergency. Yes, the mosquito bite might become very swollen, itchy and hard; this condition is just a toxic reaction to the salivary material the insect injects into your skin to make it easier to extract the blood. What we are talking about are the insects that sting, namely the wasp, yellow jacket, hornet, bee, and fire ant.

An allergic sting reaction occurs within minutes with the development of itchy hives, shortness of breath, swelling of the eyes, itching and swelling of the throat, nasal congestion, and wheezing
What is a true allergic reaction?
Most people, when stung, only suffer from local, toxic reactions, which consist of pain at the sting site and localized swelling. Sometimes, the swelling can be extensive, but localized to the area. There are no systemic symptoms. An allergic reaction consists of a generalized systemic reaction that is distant from the sting site. An allergic sting reaction occurs within minutes with the development of itchy hives, shortness of breath, swelling of the eyes, itching and swelling of the throat, nasal congestion, and wheezing. You may have one or several of these symptoms occurring at the same time. Treatment must be administered immediately. These stinging insects each have a distinct look and it’s important to know which insect is responsible for the sting. (If possible, bring the insect with you to your doctor to be identified).

Types of Stings
The honeybee generally has a rounded fuzzy body, is usually dark brown, and has yellow markings. When stinging, these bees generally will leave their barbed stinger in you as the bee tries to fly away. They will then die. Bees, other than Africanized ones (killer bees), are generally not aggressive and will only attack you if you bother them.

The wasp, sometimes called paper wasps, have elongated black, brown, or red bodies with yellow striping. They build paper-like nests with comb-like cells and are usually found around the home under eaves, behind shutters, or in bushes.

It’s always a good idea to do a “walk-around” of your home every two to three months to look for insect nests. If you find an active nest, you then may want to call a trained exterminator for advice and help.

There has been some controversy about clothing that might attract stinging insects. A recent study reports that it makes no difference whether you wear bright clothing or neutral colors. Also, perfumes and aftershave colognes may not make a difference either. There have been suggestions as to the natural body odor of some people, which may be an attractant to insects. Obviously, caution rules.
Hornets may be black or brown with yellow, white, or orange markings. These insects are generally larger than bees or wasps. They build rounded nests in trees, either hidden in the tree hollows or hanging from branches.

Fire Ants live in ant mounds and are usually found in warmer climates. They can be extremely aggressive when disturbed and will attack in mass. Fire ants have been known to kill large animals. Fire ants will bite the subject, and then use their stingers to sting multiple times.

Treatment must be immediate.
At the first signs of a systemic reaction, epinephrine should be administered using one of the available auto-injectors. The injections are usually given in the thigh or upper arm. Of course, specific treatment must be determined based on your overall health and other medications you may take. A second injection may also be necessary. The auto-injectors are prescription only and come in pediatric and adult strengths. The most noted one is the Epi-Pen. A trip to the emergency room should then follow.

After the first allergic reaction, it is most important to think about prevention. Anyone who has had an allergic reaction to a stinging insect should consult with an allergist and undergo specific testing with the understanding that allergy immunotherapy (allergy shots) may be necessary to reduce the possibility of a life-threatening event with the next sting.

During the insect season, I also recommend that my patients take an antihistamine daily such as Zyrtec, Xyzal, or Allegra. Having an antihistamine in your system may modify an allergic reaction to an insect sting, but understand that an epinephrine auto-injector would still be necessary. There is no reason why patients who are allergic to insects shouldn’t participate in outdoor activities as long as they take proper precautions and follow the advice of their allergist.

For further information, you may contact the American Academy of Allergy, Asthma, and Immunology by visiting their web site at www.aaaai.org. Have a safe and happy season.

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"The Stinging Truth"
   authored by:
Thom F. Rosenberg, M.D., a graduate of The Chicago Medical. Pediatric internship and residency @ The Childrens' Hospital of Pittsburgh. Allergy & Immunology Fellowship @ The University of Pittsburgh Hospitals and The Childrens' Hospital of Pittsburgh...

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