Anaphylaxis attack

[bunbury]

I have 3 hives that I keep in my front garden. Two days ago I examined hives one and 2 without incident. No 3 was a little cross but nothing out of the ordinary. I was wearing Nitrile gloves and had 3 stings on the right hand.
Within a very short time I could feel my pulse thudding in my head and I began to feel hot . I just managed to get the hive closed up and then staggered to the garage where with maximum will power I managed to get off my gloves, smock, white over trousers and boots. I then slumped onto a stool that was in a corner otherwise I would have fallen onto the floor.
Sweat was pouring off my forehead and running down my back. Blotches started to appear on my arms that in time coalesced into red areas. I bent forward to avoid fainting and stayed in this position for about an hour or perhaps longer. Summoning just enough energy to move I staggered upstairs an collapsed on my bed.I took a tablet of Piriteze and rubbed so rather old Anthisan over the bite sites. After a couple of hours I had recovered somewhat and after a meal went to bed and slept the night through. The only symptom I was left with the next day was a swelling under the chin.
I am very grateful for the article by hedgerow pete and inter alia Karol that have given me ammunition to fire at the GP when I see her on Thursday.
I suppose I was very luckythat I did not need or was able to get the whole gambit of ambulance and hospitalisation.

The fundamental question is do I give up Beekeeping. Any advice particularly from other Anaphlyactic suffers would be very welcome.

 

[richiel100]

Sorry to hear of your woes. Sounds like a scary experience.

is this a "new" type of reaction for you?

certainly would not inspect your bees again alone.......

 

[drfraz]

If anyone has a similar reaction then please dial 999 or 112 and lie down where they can get to you easily!
Don't worry about getting undressed or wasting anyones time, it's this sort of thing that the emergency services are for. What you needed was adrenaline & antihisamines aren't going to cut it. This is a good example of why people still die of Anaphylaxis in this country.
And please listen to your GP when she tells you that it may be time to put off beekeeping for a while rather than go in demanding Epipens & desensitisation treatments.

 

[Luminos]

I hope the GP can give you some good news. Good luck.

 

[Swarm]

Too many incidents like this being reported these days, a friend had a very similar experience but in this case, was sick and actually passed out. Hospital, adrenaline, a very scary episode.
It comes down to which you value most, your life or your hobby. If you are determined to continue with beekeeping, the long process of desensitisation seems the only option.

 

[MartinL]

........ I was wearing Nitrile gloves and had 3 stings on the right hand.
...........The fundamental question is do I give up Beekeeping. Any advice particularly from other Anaphlyactic suffers would be very welcome.

Perhaps the correct PPE, ie proper (sting proof) gloves???

 

[flotess]

As a local responder for the ambulance service I agree with the above... and would stress that AS SOON as you sense something out of the ordinary then 999. Seconds count in this situation and it can go badly wrong with very little notice. Get a crew mobile to you at the EARLIEST opportunity. They will never be put out if it turns out all OK.
They will give you the best instructions over the phone whilst the crew gets to you. These calls typically receive the highest priority (which shows you how serious the professionals take it), but even so it will take them some time to get to you... hence get them rolling at the earliest!
Take care out there!

Mark

 

[BBG]

Are you using NSAIDs? I had a lot worse experience than you! Oh, and doctors aren't always the brightest of people as I think you already know.

The doctor my wife spoke to in 1985 while I was having my attack said, "He'll probably be all right." - Grade A!

378 BRITISH MEDICAL JOURNAL VOLUME 292 8 FEBRUARY 1986
Sensitivity to insect stings in patients
taking anti-inflammatory drugs
Bee sting are known to cause various reactions in different patients as well as
on different occasions in the same patient. Anaphylactic reactions have been
described in people who had previously developed no reaction to bee stings,
and apparent spontaneous cure of their sen=sitivity has been reported.' We
report two cases of sensitivity to bee stings occurring while patients were
taking anti-inflammatory drugs.
Case reports
Case I-A 66 year old beekeeper had developed apparent immunity to bee
stings over six years. She was prescribed diclofenac 50 mg three times daily for
severe bilateral hip osteoarthrosis, not taking other drugs andnever having taken
steroids. Some. months after -starting the anti-inflammatory treatment, however,
she was stung on the wrists while attending her beehives and within 15
minutes developed an aarming reaction with palpitations, a rash over the trunk
and limbs, and swelling ofthe mouth and tongue causing dyspnoea. This settled
spontaneously within a few hours. The following day she did not take any drugs
but again sustained several bee sings, and although a similar reaction developed,
it was much mildern The next day-48 hours after her last dose of the
diclofenac-fluther bee stings had no effect. She took no more anti-inflammatory
drugs and had no further reactions.
Case 2-The 48 year old wife of a beekeeper had previously had only local
reactions towasp stings. She had taken ibuprofen for osteoarthritis of the spine
for five mhonths before she was stung by a wasp. Within two minutes generalised
swelling, red itchy rash, palpitations, and shortness of breath developed, with a
senseofimpendingdoom. Tr¢atmentinhospitalfor24hoursincluded parenteral
adrenaline, antihistamine, and hydrocortisone. Another waspstnmg her two days
Later, after she had stopped takting ibuprofen, and a less severe reaction
developed, possibly helped by speedier transfer to-hospital.- Further antiBRITISH
MEDICAL JOURNAL VOLUME 292 8 FEBRUARY 1986 379
inflammatory drugs were taken and she began a course of desensitisation to wasp
venom.
Comment
Immunity to bee stings is well known among beekeepers, indeed it
appears that people get temporary relief from the pain of arthritis if they
sustain several bee stings. Allergy to insect stings is a local or system type I
immediate hypersensitivity reaction mediated by IgE. The effect of allergy
to anti-inflammatory drugs may not be the same in all subjects, as has been
shown in asthmatic patients sensitive to aspirin.2 Treatment with antiinflammatory
drugs is widespread and may be overlooked in victims of bee
stings as a possible complicating factor.
We have found no previous report saying that diclofenac, ibuprofen, or
other non-steroidal anti-inflammatory drugs can reversibly modify the
immune response. Though changes in specific tests have been shown in
animal and in vitro experiments," no noticeable general immunosupression
has been reported in a clinical situation.
We think that all beekeepers should be warned of this possible hazard if
prescribed non-steroidal anti-inflammatory drugs.
1 EwanPW. Allergytoinsectstings: areview.7R SocMed 1985;78:234-9.
2 Asad SL, Kemeny DM, Youlten LJF, Frankland AW, Lessof MH. Effect of aspirin in "aspirin
sensitive" patients. BrMedJ 1984;288:745-8.
3 Aleksandrowa GM, Roshkowa WN, Borissowa LN. Study comparing immunotrophic effects of
diclofenac sodium, indomethacin and sodium salicylate. Farmakol Toksikol 1981;44:450-3.
4 Lang G, Phumb N, Kraus H. Inflence ofdiclofenac on PHA-4ymphocyte: stimulation in RA paients
and controls. Bethesda, Maryland: International League against Rheumatism, 1977:256.
(Abstracts from XIV International congress of rheumatology.)
5 Wildfeuer A. Effect of anti-rheumatic drugs on the release of lysosomal enzymes from human
leukocytes. Z Rhewmatol 1984;43:23-6.
(Accepted 30 October 1985)
Department ofOrthopaedic Surgery, East Birmingham Hospital, Birmingham
B9 5ST

 

[nesshughes]

This happened to me a few weeks ago, as I posted at the time - I had a night in hospital and was discharged by a doctor who offered no follow up but said lets wait and see what happens next time you are stung. I wasn't happy with this so was referred to an immunologist. I got blood test results last Friday and have now been given an anaphylaxis kit, comprising 2 epipens, steroids and ceterizine tablets. I have also been referred to begin immunotherapy treatment which will take 3 years. I had my bees taken away immediately and they are being looked after by a friend. I have been deliberating about continuing to keep bees for the last few weeks, I would love to continue but after speaking to the consultant the advice they give, even after desensitisation is to avoid at all costs being stung in the future. Whilst they don't give specific advice re keeping bees, they make you realise that is foolhardy in the circumstances. It is a hard decision, one which I haven't quite come to terms with yet, but you do have to weigh up the risks yourself after speaking to the experts, so have the blood tests and see where you go from there.

 

[nesshughes]

I should also add that if anything like this happens, the advice is to CHEW 2 piriton tablets immediately, which buys a little time if you are waiting for help.

 

[susbees]

Scary stuff Bunbury. No idea if Royal Shrews offer desensitization (nearest friend I have on treatment is in Herefordshire) but take it easy.

If you need your bees fostering out for the time being and don't have a bee buddy with space PM me...I am an Associate member of Shrops Beekeepers and have space for them if you need it.

 

[scuttlefish]

378 BRITISH MEDICAL JOURNAL VOLUME 292 8 FEBRUARY 1986
Sensitivity to insect stings in patients
taking anti-inflammatory drugs
Bee sting are known to cause various reactions in different patients as well as
on different occasions in the same patient. Anaphylactic reactions have been
described in people who had previously developed no reaction to bee stings,
and apparent spontaneous cure of their sen=sitivity has been reported.' We
report two cases of sensitivity to bee stings occurring while patients were
taking anti-inflammatory drugs.
Case reports
Case I-A 66 year old beekeeper had developed apparent immunity to bee
stings over six years. She was prescribed diclofenac 50 mg three times daily...

Oh *&@# - I've been on diclofenac for the past fortnight! That said, I've had about a dozen stings in that time and if anything the swelling has been less than usual - good to know about possible complications though, cheers BBG!

 

[tonybloke]

Are you using NSAIDs? I had a lot worse experience than you! Oh, and doctors aren't always the brightest of people as I think you already know.

The doctor my wife spoke to in 1985 while I was having my attack said, "He'll probably be all right." - Grade A!

378 BRITISH MEDICAL JOURNAL VOLUME 292 8 FEBRUARY 1986
Sensitivity to insect stings in patients
settled

erm, you say that in 1985 you had your experience, yet you seem to imply that your doctor should have read the 1986 report?

 

[bunbury]

Anaphylaxis Query/

I am indeed grateful for everyones kind and thoughtful replies.
The GP was confident that in fact I had not had an Anaphylaxis attack but an Anaphylactoid attack ie similar but not exact. He explained that there are 3 absolute criterion for the diagnosis of Anaphylaxis 1 Constriction of breathing with swelling of airways 2 Drop in blood pressure 3 skin changes.
His considered opinion was that as I had not had hospital treatment it was not Anaphylaxis otherwise as this is a life threatening condition I would be dead. He blamed the incident on a toxin response.
I will however be referred to the Immunology Dept of the local hospital for corroboration and in the meantime I have been given an Epipen and 28 Piiton tablets

 

[BBG]

erm, you say that in 1985 you had your experience, yet you seem to imply that your doctor should have read the 1986 report?

Erm, no. I'm saying that he said "He'll probably be all right."

And with or without (obviously) the report, common sense should have meant he came out or got me to hospital.

As a result, it is now accepted, and often mentioned, alluded to or otherwise and even this very thread, that

"doctors aren't always the brightest of people"

Verstein sie!

 

[BBG]

I am indeed grateful for everyones kind and thoughtful replies.
The GP was confident that in fact I had not had an Anaphylaxis attack but an Anaphylactoid attack ie similar but not exact. He explained that there are 3 absolute criterion for the diagnosis of Anaphylaxis 1 Constriction of breathing with swelling of airways 2 Drop in blood pressure 3 skin changes.

Yes, yes and yes - virtually unable to breathe due to throat swelling, ditto nose, barely able to see, large hives all over, pallid, faint - extremely unwell

His considered opinion was that as I had not had hospital treatment it was not Anaphylaxis otherwise as this is a life threatening condition I would be dead. He blamed the incident on a toxin response.

No, you can live, I did
I will however be referred to the Immunology Dept of the local hospital for corroboration and in the meantime I have been given an Epipen and 28 Piiton tablets

Which brings us to:

and "doctors aren't always the brightest of people"

BTW - what was the "toxin response."?

 

[Karol]

I am indeed grateful for everyones kind and thoughtful replies.
The GP was confident that in fact I had not had an Anaphylaxis attack but an Anaphylactoid attack ie similar but not exact. He explained that there are 3 absolute criterion for the diagnosis of Anaphylaxis 1 Constriction of breathing with swelling of airways 2 Drop in blood pressure 3 skin changes.
His considered opinion was that as I had not had hospital treatment it was not Anaphylaxis otherwise as this is a life threatening condition I would be dead. He blamed the incident on a toxin response.
I will however be referred to the Immunology Dept of the local hospital for corroboration and in the meantime I have been given an Epipen and 28 Piiton tablets

I would have to concur with your GP. I do think that you took an awful risk in not calling for an ambulance. You certainly had two of the three symptoms and you were very lucky not to have had the third, i.e. the constriction of the airways. The advice to every one on the forum has to be that if after being stung you exhibit any one of the symptoms the appropriate course of action is to call 999 and not to wait for the symptoms to get worse because in anaphylaxis, those few minutes may make all the difference. The caveat here with respect to skin changes is swelling and redness away from the site of the sting particularly around the throat and face and especially the tongue. Early warning symptoms include a tingling of the lips or tongue itself and sometimes a 'hot' sensation there as well. Swelling of the skin around the site of the sting itself is not a sign of anaphylaxis.

All that said, by the time you have your visit to the immunologist you may well find that you've developed a full blown allergy and be prone to anaphylaxis the next time that you are stung. The interesting thing about hymenoptera stings is that roughly speaking 20% of those people stung that reacted badly won't react as badly the next time, 20% of those that didn't react badly the first time will react severely the next time and 60% of people won't see a change in their reaction. The propblem is that it's impossible to predict how any particular individual will react the next time they are stung. Allergy testing is only about 95% accurate and it's a bit like an MOT. It's only valid at the time of the test thereafter your body may have changed or you may have been exposed to a different challenge (e.g. viral infection) which undermines your immune system and makes you susceptible. Did you know for instance there is a mosquito/wasp syndrome where if a person is bitten by a mosquito before being stung by a wasp then they may develop a severe reaction to the wasp sting. Presumably, if this is possible with wasps then it will also be possible with bees as well despite the venoms being slightly different.

Professionally this is a little tricky for me but suffice it to say that I am not instructing anyone to take the following course of action in the event that they develop anaphylaxis:- I'm not sure that I concur with the advice about lying down and remaining calm. I think that might actually exacerbate things. The body's natural defence against anaphylaxis is to produce adrenaline. The quickest way to produce adrenaline is through activity. Remaining calm and lying down suppresses natural adrenaline production. One of the problems with anaphylaxis is that the sudden drop in blood pressure resulting from vasodilation (opening up of blood vessels) can result in fainting and falls so sitting or lying down is probably wise but if it were me I would be tempted to try flailing (vigorously pumping) my arms and legs to try to encourage natural adrenaline production rather than remaining calm.

I read a paper sometime ago about a family of doctors who went out on their motor yacht into the solent. Their 8 year old daughter was stung by a wasp hiding in their picnic hamper and she developed anaphylaxis. Her parents managed to keep her alive by getting her to run on the spot which she did until they could get into Southampton.

It's interesting that your GP suggested that you had a response to envenomation. Again, I think he is correct. Whilst most attention is focused on anaphylaxis when it comes to hymenoptera stings in actual fact there is a whole array of possible reactions quite distinct to anaphylaxis. In another recent paper that I read, it is estimated that 40% of people stung by hymenopterans will develop angina to varying degrees ranging from the symptomless to the crushing chest pain and full blown heart attack and anywhere in between.

Anyway - the brilliant news is that you're fit and well and long may you remain that way :0)

 

[Karol]

Which brings us to:

and "doctors aren't always the brightest of people"

BTW - what was the "toxin response."?

That's not a simple question to answer. There are direct toxic effects and indirect toxic effects. See for example http://en.wikipedia.org/wiki/Serum_sickness. It is quite possible that having been stung previously, antibodies had been produced to bee venom resulting in a form of 'serum sickness' in response to a subsequent sting. There are four different types of allergic response that are potentially possible from a hymenoptera sting of which anaphylaxis (Type I) is most widely known. The other reactions can be equally life threatening but may not develop for days afterwards.

 

[MartinL]

Erm, no. I'm saying that he said "He'll probably be all right."
................

"doctors aren't always the brightest of people"

Perhaps, even so in this case he was correct!

And, had you been wearing correct PPE you would not have been stung, so who made the greatest mistake?

 

[Beeyonce]

I had a scary reaction last weekend too and am waiting to be referred to the immunology clinic.

In the meantime I've not given up beekeeping but when I performed a manipulation last weekend I was very careful with what I was wearing. Jeans and long sleeves under the suit, double gloved with marigolds and goatskin and finally realised why the 'female' part of the velcro is so long (to really pull the hood down). Was sweating like a pig (sorry) and this was made worse by the fact that I was really nervous about being stung. But I don't want to give up, so got to be done. I realise I've been a bit blase in the past, especially having witnessed the 'old boys' not even bothering to wear a suit.

Please take care, sweetie. You've had a warning!