Almost everybody experiences a bee sting sometime in their life, although only a few people have more than a mild reaction to the stings. Adults react more commonly than children, and old people more seriously than young.

Anaphylaxis, which is potentially fatal, is the main worry about bee stings, although if you get stung in your throat, or by 10 or more insects there is risk of problems from the venom alone.

The usual reaction to a bee sting is sudden pain, a small swelling that lessens later in the day, after which there is recovery. A large local reaction can occur where the swelling increases over a 2-3 day period and can last for 7 – 10 days. This is called a large local reaction, and considered to be an allergy, but carries no increased likelihood for anaphylaxis.

A bee sting with hives developing on the skin but no other symptoms usually requires nothing more than an antihistamine. Interestingly, I had a bee sting on my foot after walking on the beach, became itchy all over and developed hives, received desensitization, and had no more trouble with the several stings I had later.

Anaphylaxis is defined as a reaction distant to the site of the bee sting that involves more than one organ system. For instance you might have hives and wheezing, hives and dizziness, or any number of other combination of organ involvements or sickness.

If anaphylaxis results from the sting, it is best to be referred to an allergist.

Interestingly, bee sting allergy is NOT more common with allergic individuals, even though they may have more severe reactions. Apparently, the sting reactions are dependent upon an excess number of a cell called the mast cell, and this is determined by a serum test for tryptase.

The allergist usually performs skin or blood tests to determine whether there is sensitivity to insect stings; in addition to the Honeybee, yellow jackets and to a lesser degree other stinging insects called Hymenoptera can produce analyphaxis.

Desensitization is the only curative treatment for anaphylactic reactions to stinging insects. In addition, rapidly administered epinephrine or adrenalin, such as an EpiPen, as well as antihistamines, are usually kept on hand for use in case of a bee sting.

When I first started practice, we made our own extracts using the whole bee. Unfortunately, the digestive tract enzymes in the bee destroyed the protein of the venom so that our materials were not sufficiently active. Even after pure venom extracts became available, we also would give injections to individuals who developed hives as the only reaction other than the pain and swelling of the sting. A large study showed that  desensitization for a large local reactions, or hives only, was not warranted.

Medical science continues to advance, and you are well advised to go to the best-trained specialist you can find for bee sting anaphylaxis. Your life may depend on it.

—Dr. C.