CNN Türk – July 29, 2021
While bee stings usually cause some swelling at the sting site, they can sometimes cause a very serious allergic reaction, which we define as allergic shock.
Stating that serious allergic reactions due to bee stings are seen in approximately 1% of children and 3% of adults, Prof. Dr. Ahmet Akçay gave important information about bee allergies.
What symptoms develop in a bee sting?
Depending on the bee sting, there is usually a small swelling, redness, burning and itching in the place where the bee stings. These reactions usually resolve within a few hours to a few days, either by taking some precautions or on their own. Sometimes an allergic reaction can be seen due to a bee sting.
How do I know if an allergy has developed due to a bee sting?
Allergic reaction may develop due to insect stings. When the swelling at the sting site due to a bee sting is greater than 10 cm, it means a great reaction has developed. Bee sting allergy starts with swelling around the sting site and this swelling occurs within a few hours, swelling increases for one to two days and then improves within three to ten days. Large swellings can be seen in 1 out of every 4 people. Having great swelling does not mean that the bee allergy is a serious allergic reaction, and it does not mean that there will be a serious allergic reaction later on. Sometimes serious allergic reactions due to bee stings can sometimes lead to death.
How do I know if a serious allergic reaction has developed due to a bee sting?
Serious allergic reactions due to bee stings are of two types. The first type is allergic symptoms that are seen only on the skin, and the second type is respiratory distress and a decrease in blood pressure. In allergic reactions affecting the skin, common urticaria, swelling, itching and redness occur in our body. Serious allergic reactions in children are usually in this way. In adults, this is not the case.
When a serious reaction due to a bee sting develops in adults, only the skin does not have symptoms. Along with the common hives and swelling on the skin, cough, wheezing, shortness of breath, throat tightness, abdominal pain, nausea, vomiting, diarrhea and decrease in blood pressure, and accelerated pulse can be seen. One in five people who develop allergic shock do not have allergic symptoms on the skin. As a result, while severe allergic reactions due to bee stings are seen on the skin in children, symptoms such as a decrease in blood pressure, rapid pulse and shortness of breath are observed in adults.
When do allergy symptoms appear after a bee sting?
Serious allergic reactions are more common in adults than children. One in every 15 adults and one in every 30 children have a severe allergic reaction. Serious allergic reactions occur within minutes of a bee sting.
An allergic reaction to a bee develops within 20 minutes in 3 out of 4 people. 90% develop in the first 40 minutes. Sometimes a serious allergic reaction can develop even 5 hours after the insect sting. More serious reactions may occur if there are multiple stings at the same time or if there are repeated stings in a short period of time, such as less than 2 months. In general, the faster allergic reactions develop after a bee sting, the greater the severity of the allergic reaction. Half of all fatal reactions occur in people without a previous bee allergy.
Who is at high risk of developing serious allergies due to bee stings?
If only the signs of an allergic reaction are seen on the skin due to the bee sting, the risk of developing a serious allergic reaction in the future is low. Only one in 10 people who develop an allergic reaction on the skin has a risk of developing a reaction that affects the heart and respiration in the future. If there is a decrease in blood pressure and shortness of breath due to a bee sting, the risk of developing a serious allergic reaction due to a bee sting is 50% on average. One in 10 people with swelling larger than 10 cm due to a bee sting develops a severe allergic reaction. In those who have a risk of serious reaction due to insect sting, the risk of serious allergic reaction is evaluated with some blood tests. It is also useful to know that half of all fatal reactions are seen in people who do not have a history of reaction to a bee sting.
As a result, those at risk of serious reactions to bee allergy:
– Those who have had a serious or almost fatal reaction to insect stings,
Those who had allergic shock due to bee stings during allergy vaccination,
– Those with severe honey bee allergy,
Those with mastocytosis
Those with medical problems such as uncontrolled asthma are at higher risk of serious reactions.
One of the biggest concerns is that 50% of fatal bee sting reactions occur with the first reaction and therefore only those with a history of reactions cannot be prevented with available testing and treatments.
How is bee allergy diagnosed?
Bee allergy symptoms should be carefully questioned in those with bee stings.
How is bee allergy diagnosed?
Bee allergy symptoms should be carefully questioned in those with bee stings. If there are symptoms, allergy tests are helpful in diagnosis. The environment in which the insect stings and, if possible, the visual identification of the insect and whether the insect has left an embedded needle in the skin also provide us with important information for diagnosis. It should also be questioned whether the symptoms develop rapidly after insect bites. Information such as the presence and/or absence of skin manifestations and whether the patient needs to sit or lie down should be questioned. History of previous stings and/or severe allergy attacks should also be evaluated.
It is very important whether you have asthma or not. It is a risk factor for more severe allergic shock, especially in those with poor asthma control. Apart from asthma, other allergic diseases should also be reviewed. All medications should be questioned, especially if they are blood pressure medication used. Some blood pressure medications can cause an allergic reaction to be more serious.
In insect allergies, allergy testing should only be done in those who develop allergic shock after an insect sting. Because the risk of serious allergic reaction is low in those who have a serious skin reaction and big swelling due to a bee sting. Therefore, allergy testing is not necessary in these cases. Allergy testing is also not required for screening test in patients who do not develop severe bee-related allergies. Although bee-related allergy does not develop, there is often bee sensitivity in allergy tests.
One out of every five people has sensitivity to bees in allergy tests. Of these, only one in ten people has a future risk of an allergic reaction to bees. There is no need to test for bee allergy just because there is someone in the family with a bee allergy. It is usually not inherited and asymptomatic sensitization is possible.
The bee-related allergy test should be done without allergies in patients with mastocytosis. In these patients, bee stings are the most common cause of allergic shock, and reactions are more severe and potentially fatal if they occur. Testing is required in patients with mastocytosis, those with insect bites, even if they have no previous history of reactions.
What tests are needed to diagnose bee allergy?
Skin test and blood tests are used in diagnosis. However, blood test sensitivity is lower than skin test. Cross-reactions and true allergies can occur with the Madx Mat molecular allergy test.
Should everyone have an allergy test for bee allergy?
No. Because one out of every 5 people already has sensitivity in the allergy test against bees. This sensitivity does not cause allergies or serious reactions. Half of the fatal reactions are seen in people who have not had a bee sting before. As a result, there is no need for someone who has no complaints to have a test to see if I have a bee allergy.
What is the first treatment for a bee sting?
If a large swelling has developed in the bee sting, antihistamines, pain relievers and cold compresses can be applied. Cortisone therapy may be considered if the swelling is very large and has developed in certain areas such as the head and neck. Antibiotics are not necessary.
If there is a skin reaction in places other than the bee sting, symptomatic measures such as antihistamines are required. Cortisone treatment is usually not needed.
If allergic shock has developed, intramuscular adrenaline is administered first. Then an ambulance is called and observation is made for at least 4 to 6 hours. Position is important in treatment. Because the risk of death due to allergic shock increases in outpatients. In allergic shock, antihistamines, breathing treatments, intravenous serum therapy and oxygen therapy may be required.
Observation in the emergency room should be at least 4 to 6 hours. Prior to discharge from the emergency room, patients with an allergic shock reaction should be prescribed self-injectable adrenaline.
Can deaths be prevented if those with bee allergies carry an adrenaline emergency sting?
In bee allergy, it is necessary to carry an adrenaline emergency injection only for those who have allergic shock. Sometimes the person with bee allergy and the doctor may need to decide together. Patients with insect stings may be advised to carry an emergency kit consisting of an adrenaline auto-injector, antihistamines, and cortisone, depending on the severity of the previous sting reaction.
How can we take precautions against bee allergy?
Those allergic to bee stings should take avoidance measures, these include:
-Avoid walking barefoot outside
– Covering the arms/legs when outside for a long time,
-Staying away from open food such as outdoor litter boxes,
-Refrain from eating/drinking outdoors as much as possible.
– Insect repellants will not prevent insect stings, but insecticides can be effective.
-An indication of a bee allergy, such as a tag, necklace or ID card, can be used. -People who have had allergic shock due to bee stings should undergo allergy testing and should be evaluated by an allergist to review whether allergy shots are necessary. – An emergency action plan should be prepared in case of allergic shock.
Can bee allergy be cured?
If there is a bee allergy, it will not heal on its own. Bee allergy allergists should evaluate the severity of the allergy and whether vaccination is necessary. Chances of recovery are high with vaccine treatment
Does vaccination against bees help?
Vaccine treatment against bees is 80% effective on honey bees and 95% on wasps. With vaccine treatment, the risk of allergic shock decreases from 70% to approximately 2%. These rates are against a single bee sting. The risk of multiple and simultaneous bee stings may be high. Vaccine treatment is generally effective against 2 to 5 bee stings. For this reason, it would be beneficial to vaccinate against bee allergy to those who suffer from allergic shock due to bee allergy.
Can bee allergy-related deaths be prevented with allergy vaccines?
Allergy vaccine is an effective treatment method because it prevents the development of such a reaction in the future in those who have developed allergic shock due to bee stings.
– Bee-related allergy vaccination should be administered to children and adults who have had allergic shock and whose sensitivity to the responsible bee venom has been determined by allergy tests.
It may also be considered for adults who, despite having only skin symptoms, are at high risk of re-exposure to insect bites or at risk of impaired quality of life.
As a result, the allergy vaccine:
– It can be recommended for children and adults who have allergic shock who has been found to be allergic to bees in allergy tests.
– If recurrent large swelling reactions occur due to bee stings, allergy vaccination may be recommended to reduce the size and duration of the reactions.
Considering that 50% of fatal sting reactions occur with the first reaction, it would be a more correct approach to decide on the vaccine decision by evaluating the patient’s desire, psychology and risks together.
Importance of madx mat molecular allergy test in vaccine selection for bee allergy.
Choosing the right vaccine is important if bee allergy is to be effective. In bee allergy, the rate of allergy to more than one insect is high. This may be due to cross-reaction. With molecular allergy testing, true allergies can be separated by cross-reaction. For this reason, it will be useful to plan an allergy vaccine according to the madx mat molecular allergy test when necessary in bee allergy. Because the Madx Mat molecular allergy test is analyzed and interpreted by allergy specialists, it may be a more accurate test choice. Sometimes, allergy vaccines can be developed for both bee species.
At what age can bee allergy vaccine be given?
Bee allergy vaccination is started after 5 years of age. However, vaccination can be considered in children under the age of five. It should be considered especially in the case of severe insect sting reactions and when the child is likely to adapt.
How to make a bee-related allergy vaccine?
It is administered as an injection under the skin. First of all, the vaccine is applied once a week for the first 6 months, then the intervals are opened and the treatment is done once a month after the 12th month of the treatment. Bee allergy vaccine is effective against 2 to 5 bee stings after 1 year. Beekeepers with a higher risk of bee stings can be treated with a higher dose of vaccine. Vaccine treatment in children is given at a lower dose than in adults.
It is recommended to be given every 6 weeks after the second year and every 8 weeks after the third year. It is recommended to be applied every 3 months for use longer than five years and it did not cause any side effects and reduction in effect.
How long should the bee allergy vaccine be given?
It has been reported that bee-induced allergy vaccine should be administered for at least 5 years in order to have a long-lasting effect. It has been reported that a period of 3 years is sufficient in children. The decision to finish the allergy vaccination should be made according to the patient with bee allergy.
In order to cut off the allergy vaccine in bee-related allergy, a negligible level of allergy in the tests or a negative skin test can be considered as criteria. However, this is very rare in less than 5 years.
What should beekeepers do if they are allergic to bees?
If a bee stinger has developed a serious allergic reaction due to a bee sting, leaving the profession would be the right approach. Those who do not want to quit their job should take strict precautions against bee stings and have an allergy vaccination. It would be more appropriate to take a break from work in the first 6 months of bee treatment. Because the risk is high in vaccine treatment until a certain dose is reached. They should definitely have an emergency needle with them, and carry an emergency kit consisting of antihistamines and painkillers with them. Those who are engaged in beekeeping and are allergic to bees should be vaccinated at higher doses and continue their lifelong vaccine treatment.
