Jack M. has been a beekeeper in Keene, NH for over 10 years. Like most beekeepers he has suffered uneventfully through many beestings. He considers it a hazard of the job. In October 2011, however, he had a sting that was different from the rest. Almost immediately after the sting, he began to feel itchy all over, turned bright red and developed hives over his chest and abdomen. He went to the emergency room.
Jack had a generalized reaction to the honey bee venom, a rare but potentially life-threatening reaction. Approximately 3% of the adult population develops a systemic or severe allergy to beestings and 40 persons die each year from bee sting reactions. Symptoms following a bee sting are usually mild with pain and irritation at the site. Some people experience large local reactions where redness and swelling extend a distance from the site of the sting. A much smaller percentage experience systemic reactions like Jack did. In a systemic reaction, symptoms occur away from the site of the sting. Symptoms may include shortness of breath, wheezing, itchiness over the body, redness of the face and extremities, loss of consciousness, hives and trouble swallowing. Having a sting on the hand and developing hives on the chest and abdomen would be symptoms of a systemic reaction while having a sting on the right hand with swelling to the right elbow would qualify as a large local reaction. Systemic or generalized reactions are an emergency and should be treated immediately.
Beekeepers have frequent exposure to huge numbers of bees and therefore are at higher risk than the general population of frequent beestings. Beekeepers average about 58 beestings a year. The average person has far less exposure to beestings and much lower risk.
So what can be done? In the emergency room Jack was treated and fortunately did not have further progression of his symptoms. He was referred to a local allergist, advised to avoid getting stung again, and to carry an emergency EpiPen with him to use if he should have another sting.
Five types of bees are responsible for most allergic bee sting reactions. Yellow jackets are the most aggressive bees and are responsible for many beestings and reactions. They frequently build their nests in the ground and are disturbed by gardeners and landscapers. Wasps are also responsible for many stings. Honey bees tend to be docile unless disturbed. They are one of the few bees that leave their venom sac behind with their barbed stinger left in the skin.
Allergic reactions to honeybees tend to be more severe than those from other bee varieties, and honeybee allergy is more difficult to desensitize successfully. Venom allergy injections are approximately 95% successful in preventing systemic or severe reactions on subsequent stings. With honey bee injections, success is closer to only 80%. This is still far superior to the potential of 25-70% chance of a repeat severe reaction without allergy injections. Similarly while most people who have had three to five years of venom desensitization may discontinue their venom allergy injections, with honey bee allergy injections, treatment sometimes needs to be continued indefinitely to provide adequate ongoing protection.
An interesting finding among beekeepers is that with their frequent beestings, many actually desensitize themselves. Frequent stings act almost as allergy injections in providing a stimulus to the beekeeper’s immune system to make protective antibodies. But not always! With Jack and countless other beekeepers the careful symbiosis sometimes breaks down, the bees feel threatened and sting. Whether or not a severe reaction will result can’t be predicted.
At the allergist Jack was tested for five venoms including yellow jacket, yellow hornet, white face hornet, wasp and honey bee. He had an immediate reaction to honey bee venom. His doctor advised rapid desensitization since his risk of a repeat sting from a honey bee was high.
Jack is very happy to continue tending his bees. He receives a honey bee allergy injection once every month. He carries an EpiPen to use only if he were to develop another systemic reaction, unlikely on allergy injections. He wears a full protective suit when he tends his bees. The risk of a severe reaction is relatively low as long as he completes his treatment.
Beekeepers and the general public should be aware of the warning signs of a serious bee sting reaction. The reaction develops quickly life-threatening situation. If a person is having a serious reaction, call 911 immediately. If they have an EpiPen, encourage them to use it.
- Munstedt, K, Hellner M, Winter G, et al: Allergy to Bee Venom in beekeepers in Germany, J Investig Allergol Clin Immunol 2008;18(2)100-3
- Golden DB, MoffittJ, Nicklas RA editors: Stinging Insect hypersensitivity:a practice parameter, J Allergy Clin Immunol 2011;127:852-4
- BousquetG, Menardo JL, Aznar R, Robinet-Levy M, Michel FB: Clinical and immunologic survey in beekeepers in relation to their sensitization, J Allergy Clin Immunol 1984;73(3)332-40
- Golden DBK, Marsh DG, Kagey-SobotkaA et al: Epidemiology of insect venom hypersensitivity, JAMA 262:240, 1989
- Muller U, Helbling A, Berchtold E: Immunotherapy with honeybee venom and yellow jacket venom is different regarding efficacy and safety, J Allergy Clin Immunol 89:529.1992
- Golden DB, Kwiterovich KA, Addison BA, et al: Discontinuing venom immunotherapy: continued observations, J Allergy Clin Immunol 83:1049, 1989