Buzz. Buzz. Zing.
In the backyard under the crab apple tree, only one thing can abruptly ruin a lazy summer day: the sting of a bee, hornet or wasp. The same insects that float from stem to stem, coloring summer with flowers as they search for pollen, are also killers.
Millions of people could avoid life-threatening allergic reactions if they'd speak up--to a doctor. You know who you are--you've already had one severe reaction to an insect sting. In all likelihood, people who've had one bad experience are candidates for a purse or pocket-sized prescription of the drug epinephrine.
Some also may be eligible for venom immunology, the 20-year-old preventive series of shots of insect venom that is almost 100% effective in building a patient's immunity and blocking the reaction. The injections are given weekly for two or three months, then repeated every one or two months for up to five years.
But most people don't know about either option, leaving allergists almost as angry as bees in late summer. They have gone on attack, making information available where patients are likely to encounter it: emergency rooms and general doctors' offices.
Venom immunology is reserved for the severely allergic. A person can be tested for reactions and treated only after experiencing a first severe reaction.
"But the biggest thing is knowing it is available and no more dangerous than any other allergy shot," says Dr. David Golden, associate professor of medicine at Johns Hopkins University and a specialist in allergies, particularly those caused by insect stings.
"Yes, allergic reactions to shots can happen," he says, but no more often than reactions to shots for grass or dust mites. The therapy is also safe for pregnant women, he says.
Golden was the lead author of a 1989 study that determined an estimated 3% of adults and 1% of children have had allergic reactions to insect stings. The big surprise in the study was that nine of 10 people who suffered bad reactions to stings never told their doctors. As many as 10 million people are hypersensitive enough to require extra protection; but many who know they are at risk shrug it off, assuming they will not be stung again. Sometimes they're right, but sometimes the next sting brings an even more severe reaction.
Nationwide, 50 people die each year from insect bites, and many more seek critical care in hospital emergency rooms. Everyone reacts to stings of bees, wasps or hornets. Most frequently, though, the swelling and itching is local--that is, confined to the bite or affected limb.
The reactions that occur far from the sting site are what concern doctors. These so-called generalized or systemic reactions are readily apparent. Minutes after the sting, itchy welts or hives break out all over the body. In 10 to 30 minutes, a person may feel his throat tightening, have trouble breathing, feel dizzy or pass out. Loss of consciousness is caused by low blood pressure.
Allergic reactions are unpredictable. Golden says a person might be stung 50 times with no ill effects, and then the 51st time experience an allergic reaction.
Dr. Elliott Pearl, an allergy specialist with ENTAA Care, a seven-office practice in the Baltimore region, says allergic reaction can take many forms.
Children often have systemic reactions, Pearl says, but the chance of a second one is only about 15%. Adults, on the other hand, have a 60% chance of a second bad reaction.
Fatal reactions are less likely in the young. People on certain blood pressure medications or with some coronary artery diseases are at higher risk.