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 September 18, 2003
House & Home
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Insect Bites And Stings
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For most people, the bite or sting of a bee, wasp, ant, mosquito, or other insect causes minor irritation. For people allergic to insect bites or stings, the results are a lot more discomforting, and sometimes even dangerous.


For those allergic to bites and stings, their skin breaks out in hives, the eyes itch, the chest and throat feel constricted, a dry cough comes on, and there is often nausea, abdominal pain, vomiting, and dizziness. In the highly sensitive, breathing becomes difficult, speech slurred, and a sense of confusion and impending disaster may take over. In a few, rare cases, the victim will turn blue, lose control of urination, and fall into life-threatening unconsciousness or anaphylactic shock within as little as 10 minutes. Unfortunately, there is no way in advance to know which people will have the more worrisome allergic reactions. Allergy to insects exists among people who have no other allergies as well as among those who do. Even experience from past stings is no sure predictor; about half the victims of stings may have an entirely normal response on one occasion but suffer a serious allergic reaction the next time.


People are not allergic to insects per se - only to their venom. Toxic components of the venom cause the irritating local reactions everyone gets. It is the venom's other components that may provoke histamine release that triggers allergic responses. In the U.S., only a few stinging insects - honeybees, bumblebees, wasps, hornets, yellow jackets, and ants - cause serious allergic reactions. Of these six, reactions to the yellow jacket and the honeybee are the most common. Mild reactions can also be caused by biting flies, mosquitoes, ticks, and a few spiders. A nasty newcomer to the list of troublesome insects is the fire ant. The ant actually bites first, and then, hanging on like a bulldog, swivels about, stinging repeatedly. The potent venom is a very real hazard to those allergic to it, capable of causing severe systemic reactions.


For many, an insect bite causes momentary pain followed by redness, irritation, and itching around the wound for a few hours. However, the reaction to an insect sting can be immediate or delayed. In most cases, the sooner the reaction starts, the more severe it will be. Systemic (throughout the body) responses usually begin in 10 to 20 minutes. Delayed reactions can occur several hours to several days later, producing painful joints, fever, hives, and swollen lymph glands. Both immediate and delayed reactions can occur in the same person following a sting.


In honeybee stings, the venom gland often remains attached to the stinger. To remove the stinger without pushing the venom into the wound, gently scrape or flick it out, using your fingernail or knife. Do not squeeze the skin around the stinger because you can push more poison into the skin. Wash the site thoroughly with soap and water. Dab on an antiseptic to prevent infection. To reduce swelling and prevent venom from spreading, wrap ice in a cloth and quickly apply it to the sting. Leave in place for 20 to 30 minutes. With bumblebee stings, the insects do not lose their stingers when they attack and can sting repeatedly. Treatment involves washing the site of the sting with soap and water and use of an antiseptic to prevent infection. To reduce swelling and prevent venom from spreading, wrap ice in a cloth and quickly apply it to the sting. Leave in place for 20 to 30 minutes. For mosquito bites, wash the affected areas thoroughly with soap and water. Dab on an antiseptic to prevent infection. To reduce swelling and to help soothe the itching, apply a paste made from one teaspoon baking soda mixed with one teaspoon water. If itching persists, take an over-the-counter antihistamine as directed. Fire ants have large curved jaws and a bee-like stinger on the tail. This arrangement explains the stinging pattern: they hang on with their mouth, then rotate in a circle while stinging with their tail. Treatment involves applying cool compresses of ice wrapped in cloth to soothe the sting. A paste made from baking soda mixed with water may help. Take aspirin or ibuprofen to reduce pain or swelling, as directed. A serious response to insect bites and stings should be treated as an emergency. A double dose of antihistamine will decrease the severity of the reaction, but the most effective treatment is an injection of adrenaline or epinephrine. In acute shock or airway closure, intravenous fluids, oxygen and a surgical opening in the windpipe may be necessary. For people with known insect allergy, many physicians recommend carrying an emergency kit containing epinephrine in a syringe ready for injection, antihistamine tablets and alcohol swabs.


Sensitive patients should not walk barefoot outdoors because yellow jackets nest in the ground. Garbage cans should be well covered and affected individuals should avoid outdoor eating if possible.


What type of insect caused the sting? Is this an allergic reaction to the insect sting? What treatment do you recommend? What can be done in the future to prevent further insect bites and stings? Should antihistamines be taken upon being stung? If allergic, will anaphylactic shock be experienced? Under what circumstances should emergency treatment be given? Is it necessary to carry an emergency kit containing epinephrine?

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