Bee stings

Bee stings are a defensive mechanism that honey bees use when threatened. Only female honey bees (worker and queen bees) have stings. These stings are barbed which is why they remain embedded in your skin. Honey bees will die once they have released their sting.

Hypersensitivity to insect stings occurs in up to 5-7.5% of the population, and up to 1/3 of beekeepers. Most people will have a mild reaction from stings (e.g. localised itch and swelling). Bee venom allergy is one of the most common causes of anaphylaxis, a severe, life-threatening reaction.

Minor reactions

First aid is adequate for the treatment of minor allergic reactions to bees. Flicking the sting out as soon as possible will reduce the amount of venom injected. Use the edge of your fingernail, a care key or credit card to flick it out. Try not to squeeze the venom sac, as this may increase the amount of venom injected. Cold packs and soothing creams help for minor reactions and oral antihistamines can be useful.

Anaphylaxis

Signs and symptoms of anaphylaxis to bee venom include trouble breathing, feeling faint and dizzy (a sign of drop in blood pressure), and/or abdominal pain including vomiting and diarrhoea. This may be accompanied with an all-over rash. It is important to note that in some cases, the person may just lose consciousness; i.e., faint (collapse), without any other signs. Symptoms can also occur quickly—within five minutes of being stung—and rarely beyond an hour.

The symptoms of anaphylaxis are caused by an over-reaction of the immune system to the venom that has been injected. In the reaction, the immune system releases histamine and other chemicals which cause tissue—such as the tongue, throat and/or the airways in the lungs, and/or blood vessels in the circulatory system—to swell and leak. This can lead to the person being unable to breathe, and/or to cardiac arrest.

Treatment for anaphylaxis

The first step is for the person to lie down and if possible, have legs elevated. This is to counter the sudden drop in blood pressure they may be experiencing. Someone experiencing anaphylaxis should not stand or walk as this will worsen the reaction. Flick out the insect sting as soon as possible.

If an EpiPen is available, give this as quickly as possible, per the instructions on the Anaphylaxis Action Plan, then call 111 for an ambulance. The person must remain lying down and paramedics come to them, not attempt to walk for help. They will be taken to the emergency department and given further treatment, if needed, and remain under observation for at least four hours.

Analyphylaxis resources can be found on www.allergy.org.au including action plans and free online training. See additional links below:

ASCIA Action Plan: Anaphylaxis – Australasian Society of Clinical Immunology and Allergy (ASCIA)

Anaphylaxis e-training first aid (community) – Australasian Society of Clinical Immunology and Allergy (ASCIA)

ACC and immunotherapy

Beekeepers may not be aware that the emergency treatment for anaphylaxis to a bee sting is covered by ACC. This covers the ambulance cost, and the person can also claim reimbursement for using their own EpiPen if this is the case. More information is available here.

Anyone who has had an anaphylactic reaction to bee venom should be referred to a clinical immunology and allergy specialist for follow-up including to assess future risk, provide an Anaphylaxis Action Plan, prescription for EpiPens, and advice on immunotherapy as a treatment.

Venom immunotherapy (VIT) is usually recommended for those who have had anaphylaxis, as it can significantly reduce the risk of having a severe reaction if stung by a bee again. The vaccine for the treatment is funded by Pharmac, and it is given by regular injections for five years in most cases. The first (initiation) phase is usually administered in a hospital or outpatient setting under specialist supervision. Ongoing injections may then be done by GPs who have resuscitation equipment available and are comfortable to carry the injections on. Patients should approach their GP before they start the whole initiation process to make sure they are willing to do this.

VIT can result in long-term tolerance to bee venom for 10–20 years and sometimes longer. However, it is not suitable for some people such as with other health conditions, and this needs to be assessed by an allergy specialist.

Beekeeper responsibilities

There is a 3-5% chance of an anaphylaxic reaction to bee venom. Beekeepers should identify this as a fairly high risk and have a health and safety management plan in place. It is best practice to carry emergency treatments that can be self-medicated. The most user-friendly form currently available in New Zealand is an EpiPen. When in the field, it is also important to know where your nearest ambulance base is, if you need to call emergency services.