After the Sting
For most people stung by a bee, there’s a burning sensation at the sting site followed by a red bump that aches and itches. Other people may experience more serious reactions – widespread swelling, hives, shortness of breath, fainting or worse.
If you’re in the second group, what happens next? Do you have to be afraid of bees for the rest of your life?
“No, what most people don’t know – and even many doctors are unaware of – is that there is a treatment available that essentially cures the allergy,” says allergist David Golden, MD, a specialist in insect sting allergy at Johns Hopkins School of Medicine in Baltimore. “Someone who has had a severe allergic reaction doesn’t have to ever have another.”
The treatment is immunotherapy – a series of allergy shots that gradually build tolerance.
“Almost 100 percent of people who receive immunotherapy are fully protected from severe reactions, and up to 85 percent who complete the treatment will be cured,” Dr. Golden says. “With a life-threatening allergy like insect sting, it’s worth the effort.”
When to see an allergist
Anyone who has had life-threatening symptoms after a sting such as trouble breathing or dizziness should definitely see a board-certified allergist, Dr. Golden says.
Other symptoms like hives in children or widespread swelling, while alarming, don’t actually point to future risk, but a visit to an allergist can help remove fear.
“An allergist will be able to tell whether your insect sting is dangerous,” Dr. Golden explains.
What to expect
Not everyone who comes to see Dr. Golden after an insect sting gets an allergy test.
“We only do them when someone’s history of sting reaction puts them at high risk for anaphylaxis, a life-threatening reaction,” he says. “We need to identify which insects they are allergic to so we can use the appropriate venom for immunotherapy.”
Most will have skin tests for yellow jackets, two different hornets, wasps and honeybee.
“By and large, insect allergy is not something that runs in families,“
Dr. Golden adds, so he doesn’t recommend preventive testing for family members, even for children.
Allergists concerned about the risk of a severe allergic reaction may prefer blood tests over skin tests, but Dr. Golden says this is unfounded: “If you do skin testing carefully and properly it’s really quite safe.”
Some allergists delay venom testing for a month after a sting to ensure accurate results, but Dr. Golden prefers not to wait. “I want to get the person protected with immunotherapy as soon as possible,” he says.
The next step
Venom immunotherapy is done in two stages. The first builds immunity with shots that contain gradually increasing concentrations of allergen once a week for 8-20 weeks, depending on the kind of vaccine the physician chooses.
At the end of the first stage, you reach the maximum dose and are fully protected from stings.
After that, the second stage develops long-lasting immunity with booster shots every 1-2 months.
“After five years of treatment, most people can stop immunotherapy and never have another allergic reaction to a sting,” Dr. Golden says.
— By Laurie Ross
Reviewed by Michael Mellon, MD
Learn more about insect stings and allergies.
David Lang, MD, a board-certified allergist and chair of the department of allergy and clinical immunology at Cleveland Clinic, recently hosted a “Venom Allergies 101” webinar presented by Allergy & Asthma Network. The hour-long webinar, sponsored by Mylan Specialty L.P., is available for viewing at www.allergyasthmanetwork.org/venom-allergy-101-webinar-with-david-lang/.