Sonia was out shopping for her bridal gown on a sweltering day. She stopped on the sidewalk to throw away her smoothie cup. Buzzing around the trash bin was a yellow jacket that stung her on the arm.
Within 15 minutes, Sonia was covered in hives from head to toe. She began coughing and became short of breath and lightheaded.
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Luckily, she was with a friend who is a pharmacist. She quickly ran into a drugstore and gave Sonia a dose of Benadryl and a puff of her own rescue inhaler.
Sonia is among the 3 percent of American adults who suffer a systemic allergic reaction to stinging insects. Fifty deaths occur every year from such reactions. Most occur in adults and in those without a prior history of a stinging-insect reaction.
Having hay fever, food allergies or allergic asthma puts you at no higher risk than average of what are known as venom allergies. Nor does having a family member with a stinging-insect allergy mean you're more likely to have one.
Stinging insects are found in many places. Generally. honeybees nest in hollow trees. Yellow jackets scavenge for food, often around trash cans and large metal bins such as Dumpsters. Hornets create nests that may hang from soffits of roofs. Wasps' nests look like honeycombs and are usually found on roof overhangs, behind shutters or in dryer vents. Fire ants create underground nests with those telltale sandy mounds. Their stings are usually in a semicircular pattern and often lead to pustules.
Everyone who gets stung by a bee, wasp, yellow jacket, hornet or fire ant will experience pain, itching, redness and swelling, normal reactions to the chemical properties of the venom. If there's just a sting or two, symptoms generally subside in an hour or so -- longer if there are more stings.
Less common is a larger area of swelling that can extend to involve the nearest joint. Children experiencing diffuse skin symptoms far away from the sting site -- such as hives -- need to be evaluated by an allergist. But rarely are they likely to develop a life-threatening reaction to a future sting.
Symptoms of a systemic allergic response can include:
• Skin involvement -- hives, flushing, swelling.
• Respiratory involvement -- difficulty breathing, coughing, wheezing, shortness of breath, chest tightness.
• Cardiovascular involvement -- chest pain, dizziness, low blood pressure, fainting.
• Gastrointestinal involvement -- nausea, vomiting, diarrhea, abdominal cramping.
Symptoms will usually occur within minutes of a sting and may include all or only a few of the above symptoms. Skin symptoms are, by far, the most common symptoms, but rarely occur alone in allergic patients.
Acute systemic symptoms should be treated with Benadryl. Systemic symptoms involving the respiratory or cardiovascular tract require immediate emergency care and require injectable epinephrine.
Ice packs and analgesics, like Tylenol or ibuprofen, also help with pain and swelling.
Any symptoms other than just localized swelling and pain should be evaluated by an allergist to identify a true allergy to venom. This may involve a basic evaluation, as well as skin testing if appropriate.
Once a venom allergy is identified, patients can learn how to avoid situations where they might be stung. Since not all stings can be prevented, they also should carry an injectable epinephrine device (commonly known as an EpiPen) and know when and how to use it. An identification bracelet or tag that can make others aware of this allergy is also a good idea.
Venom immunotherapy -- monthly allergy shots -- is the best way to prevent a life-threatening reaction in allergic patients.
Sonia was skin-tested and was found to be allergic to wasp venom only. She carries an EpiPen and is very cautious to avoid further stings. She will likely begin immunotherapy as soon as the allergist in her family can convince her to start.
I'm working on her now -- she's my sister.
• Dr. Mona V. Mangat is a board-certified allergist and immunologist in St. Petersburg, Fla., at Bay Area Allergy & Asthma.