by James Hubbard, M.D., M.P.H.

On my Facebook page, Terri asks:

What can be done if the person has a allergic reaction to a [bee] sting. What are the signs? What should I do if there is no bee sting medicine?..no medical facility.

Bee on a purple flowerGood questions. First you need to know, there are bee-sting reactions and there are REACTIONS. The second kind can hit ANYONE and kill you in minutes. I’m not exaggerating. You can go all your life and not be allergic to bee stings, and wham. It’s speculated that many outdoor sudden deaths where the cause is unknown happen from an allergic reaction to a bee sting. Recognizing the warning signs can save your life.

When to Get to the ER

Generally, a local reaction—anything from a minor ouch to a major swelling of the affected extremity—isn’t immediately life-threatening. Any reaction beyond that, and you should get to a medical facility immediately. In fact, you should go soon if you have major swelling. It can be treated with antihistamines and steroids, or antibiotics if it’s an infection. But it’s not the kind of reaction that’s going to kill you in minutes.

The lethal kind can hit within a minute or up to two hours from the time of the sting. Your blood pressure can drop, and your airways may swell. You can go into shock and die. Warning signs are:

  • Hives or welts. They can break out anywhere on your body and are raised and itchy.
  • Swelling of your face, tongue, or throat.
  • Trouble breathing.
  • Fainting.

If you have an EpiPen, use it. Call 911. Get to a medical facility ASAP. In addition to the epinephrine, they may give you oxygen and IV fluids.

Other warning signs are:

  • Dizziness.
  • Heart beating really fast.
  • A tingling or funny taste in your mouth.
  • Having an overwhelming feeling of anxiety or impending doom.

Sometimes it’s hard to tell whether these early signs are going to be significant, but again, any symptoms other than local pain or swelling you need to take seriously.

What to Do Until Help Arrives

While waiting for the ambulance, or if you can’t get to the hospital immediately:

  • Use the EpiPen.
  • Lie down, feet higher than your head. The bee-sting reaction makes your blood pressure fall, and lying down like this will help keep your blood flow going to your head and heart.
  • Take an antihistamine such as diphenhydramine (Benadry). If it were a capsule, I’d empty the contents under my tongue. I don’t know whether there’s any proof it works faster but, hey, we’re desperate.
  • If you’re having trouble breathing, use an albuterol inhaler if available. (It’s usually used for asthma or COPD).

What to Do If You Can’t Get to a Hospital

There’s no good alternative to the epinephrine, Taking the above steps, and praying, is about all you can do. So you see it’s important to have an EpiPen. In fact, it’s important to have two. Since the allergic reaction to the bee sting may last longer than the medicine, you may need a second dose if symptoms come back.

Who’s at Risk for a Deadly Allergic Reaction

Okay, now for a little less drama. Only one percent of the population is truly allergic to bees. But still, every year fifty to sixty people are known to die in the U.S. from bee stings—many never having had an allergic reaction before. As noted above, that number may be low.

If you’ve had a severe allergic reaction before, your chances are somewhere around thirty to sixty percent of having a severe reaction to the next sting. I know, not a hundred percent. Surprising, huh? Still, the odds are too high to gamble

Therefore, if you’ve had a severe allergic reaction before, you should get allergy testing and shots by an allergist. Think of it as a prep thing. Don’t delay.

What to Do for Minor Bee-Sting Reactions

For the pain and swelling of local reactions, we used to think you should find something like a credit card and scrape the stinger off. That way you wouldn’t chance squeezing in more venom. The thinking now is that you should brush off the stinger immediately, any way you can, because that stinger contracts and pumps in the venom on its own for up to a minute after the sting.

Home remedies for local reactions? Ice may help. I’ve used wet tobacco. There are plenty more. What’s yours?

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Photo by Karen Roe, Flickr.