Adult patients find using a pre-loaded adrenaline syringe (Epipen 300ug) very convenient in emergencies. They should have the dose repeated after 5 minutes if there is no satisfactory response. In children under 5 years of age, we give 0.1 to 0.3 ml of adrenaline (1:1000) depending on age and an Epipen Junior conveniently dispenses 150ug of adrenaline per dose. The patient should still immediately be taken to A&E after the adrenaline administration, for further assessment and monitoring. Measurement of Tryptase in the blood will also confirm that an allergic reaction has taken place.
Wasp and Bee avoidance measures.
People who are known to be allergic to wasps and bees should try wherever possible to avoid being stung and stay away from areas frequented by bees and wasps. If a wasp or bee approaches, remain calm and still, do not try to swat the insect as this may frighten it. If it lands on you, gently blow it off your skin. Certain people seem to attract bees and wasps and we suspect that they secrete a chemical Pheromone in the skin, which heightens the insect’s agitation.Insects are drawn to flower fragrances and bright colours with dark backgrounds. Therefore white clothing is safest for insect allergic people to wear. Avoid perfumes, uncovered cold drinks, fruit juices, sugary foods outdoors as these attract insects. Wasps also tend to creep into soda cans and other beverages. Never walk on grass barefoot and avoid orchards in blossom. Carefully shake out clothing left on the ground. Avoid mowing lawns, trimming hedges or pruning trees. Keep dustbins and food well covered. Bees and wasps tend to frequent clover fields, picnic areas and soiled dustbins in particular. If one comes across a bee hive or wasps nest in the garden, do not disturb it. Rather seek help in having it removed. A few Cloves stuck into an Orange, which is placed on the picnic table tend to discourage bees and wasps from causing a nuisance at picnics.
If stung by a bee, immediately scratch or flick off the barbed stinger (don’t squeeze more venom into the skin). Apply ice or a cold compress to the sting, in a mild reaction a freshly cut onion will soothe the skin if applied to the sting area for 20 minutes. Life threatening reactions are more likely to occur in highly allergic individuals, elderly people with pre-existing cardiac or respiratory diseases or in multiple stings. Stings to the face, neck and scalp or more likely to trigger anaphylaxis. Do not exercise or have a hot bath after a sting as this may increase the venom distribution.
Preventative measures
Patients prone to severe reactions should carry emergency medication on them and this includes an Epipen Adrenaline injector, Antihistamine medication and Prednisilone. We usually recommend the patient have 2 Epipens, one at home and the other in the workplace or school. All wasp and bee allergic people should have a Medic Alert bracelet carrying details of their allergy.Venom Desensitisation Immunotherapy is a highly successful means of treating people with severe generalised venom allergic reactions. This is particularly useful for Beekeepers, Horticulturists, Gardeners and Farmers who find it difficult to avoid stinging insects. These injections are carried out at weekly intervals during the initial treatment phase and then monthly for a further 3 years during the maintenance phase. By the end of the treatment, the patient is able to tolerate 100ug of venom, the equivalent of two bee or wasp stings, with no adverse reaction. Results are excellent, but Immunotherapy does run the risk of inducing an allergic reaction. The ALK Abello Wasp and Bee venom vaccines are extremely safe to use. Injection Immunotherapy should only be performed in specialist hospital-based clinics with readily available resuscitation equipment and the patient should be observed for one hour after each injection.
(published with permission in writing from:http://www.allergy-clinic.co.uk)
