Bee sting desensitisation course

[Luminos]

good news

 

[BeeJayBee]

Increased this week. 0.4ml injection with 0.8 amount of 1 sting. No swelling so far today which is 9hrs since the injection, there is a little bit of itching but no where as much as last week or the week before.

Feeling good for this weeks one feels like the course is working

double

 

[busybee53]

You deserve a medal. Well done.

 

[whoosling]

Increased this week. 0.4ml injection with 0.8 amount of 1 sting. No swelling so far today which is 9hrs since the injection, there is a little bit of itching but no where as much as last week or the week before.

Feeling good for this weeks one feels like the course is working

[/quote

Brilliant

 

[dpearce4]

Thank you all for all the support you have shown me while i have been going through this process.

Update for this week.

went to bed very tired at just after 9pm (more work than from the injection). Woke up at about 2.30am arm was itching, gave it a good old scratch and then went back to sleep. Woke up at usual time of 5.45 to get up for work, no itch and no swelling, this is amazing for me, havent itched all day and arm hasnt swollen.

Absolutely amazed never had a reaction like that. Hope its the shape of things to come. Feeling alot less nervous about going up to the bees, mind you will still take all precautions i normally do, better to be safe then dead.

 

[Karol]

<snip> Feeling alot less nervous about going up to the bees, mind you will still take all precautions i normally do, better to be safe then dead.

Delighted to hear the good news!

Great to be optimistic but also prudent to be cautious.

 

[freethorpe bees]

Hi

Out of interest and speaking as a fellow allergic person, do you take an antihistamine before going to the bees?

FB

 

[itma]

Hi

Out of interest and speaking as a fellow allergic person, do you take an antihistamine before going to the bees?

FB

Important to clear up something.

Desensitisation therapy is for those at risk of a severe systemic reaction - like anaphylactic shock. These folk have an excessively strong allergic reaction - they are seriously "allergic".
Antihistamines won't help much with a systemic reaction.
But they should help moderate local swelling for those with a normal (if strong) local reaction.

Subject to the usual caveats contained in the "Patient Information Leaflet", it shouldn't be harmful to take an antihistamine before you have been stung, but it won't help enough to be any use if you are one of those that have an extreme systemic response!

 

[dpearce4]

Week 11

Full sting time. Had the injection today 0.5ml equal to 1 sting. Ouch you really know when you have a 0.5ml of something injected into the back of your arm, dont look much in the syringe but you can feel it when its in the skin.

The reaction has been good, the lump from the liquid injected has gone down as the lump from venom has come up. The lump from the sting has grown to about 2cm across, it has itched a little but not enough that i have wanted to scratch it, but boy is it hot to touch and it has been really nice putting my cold hand on it.

I think the reaction is what someone that has a normal reaction would have. Im feeling really happy at the moment, I just need to see what happens overnight as thats when the worst swelling used to come up. Im really hopeful though as its really gone down in the last couple of hours and no itching at all.

 

[Chorlton Honey Bees]

what would the docs do if you took one of your girl could they or would they let her sting you the real thing would be a test not so good for her though just a thought (i now they wouldnt but i would be tempted am i mad (Yes)

all the best mate still reading with ameration

 

[dpearce4]

Hi

Out of interest and speaking as a fellow allergic person, do you take an antihistamine before going to the bees?

FB

Hiya freethorpe,

re the antihistamine, yes i always take a one a day antihistamine before going up to the bees, a recomended on the forum. Im sure they had some effect but im sure it was minor as with 1 sting in the finger and i would swell up to my elbow, sometimes with a 1inch track mark going right up to my arm pit. 2 stings on the hand and the whole of my arm would swell up (double in size) these swelling would take 5 days to go down and would itch like mad.

I will continue to take the antihistamines as i do believe they do a job, and i will continue to wear the thick blue beekeeping gloves i use as a precausion but im sure im not going to be so worried about getting stung anymore.

If you have full systemic reaction like i had last year in june ending up in crash at A&E for 6hours, you will get a really big dose of Pirition IV with steriods and adrenaline thrown in, you will ge connected to lots of lovely machines going Ping and Beep making staff come running when your blood pressure suddenly plummets due to the reaction of the venom. I can say it was a horrid experience and your heart pounding massively due to the adrenaline is really quite painful as it is much stronger than the amount in the eppi pen (emagine being unfit and sprinting, not jogging, sprinting 1mile for your life and how ur heart would pound if you had then times that by 10).

 

[dpearce4]

what would the docs do if you took one of your girl could they or would they let her sting you the real thing would be a test not so good for her though just a thought (i now they wouldnt but i would be tempted am i mad (Yes)

all the best mate still reading with ameration

There is a researcher at Lasi, sussex uni that has an alergy to bee stings. She did a talk last year at our BKA and while she was there told people that she keeps her alergy under control by taking a bee and allowing it to sting her on the back of the arm. which is basicly what the hospital is doing with the injections.

so yes they do do that, and im sure the people at the clinic would be interested to see how it went if i were to do that as they do research into other types of alergies.

 

[Karol]

Important to clear up something.

<snip>
Antihistamines won't help much with a systemic reaction.
But they should help moderate local swelling for those with a normal (if strong) local reaction.

Subject to the usual caveats contained in the "Patient Information Leaflet", it shouldn't be harmful to take an antihistamine before you have been stung, but it won't help enough to be any use if you are one of those that have an extreme systemic response!

Hmmm!

Not sure that I agree entirely with what you've written.

There's a big difference between older generation (systemic) antihistamines and newer generation (peripheral) antihistamines.

One of the primary keys to surviving anaphylaxis is protecting the airway and taking a first generation antihistamine such as chlorpheniramine (Piriton) will have an anti-inflammatory response which may well be just enough to prevent a fatality in a 'first aid' rescue situation (i.e. where prescribed adrenaline is not available).

Yes, there is an issue about delayed response but this is as much about recognising early warning signs and taking the anti-histamine early as it is about the type of formulation - so Piriton liquid works faster than tablets and chewing tablets before swallowing works faster than swallowing tablets whole. Agreed that anti-histamines are not a substitute for adrenaline but your posting could be interpreted as a recommendation not to take anti-histamines during anaphylaxis and I think on balance that that is not necessarily wise counsel.

There is quite some debate (professionally) about the merits of antihistamine use in anaphylaxis. Cochrane couldn't find any evidence for their use because there have been no formal clinical trials. However, this is not the same as saying there is no evidence of value for their use.

The fact that very few people actually die from anaphylaxis in my view suggests that existing treatment is by and large effective and this is generally adrenaline followed by IV Piriton and steroids with intravenous fluids. Taking anti-histamines won't sufficiently interrupt the cascade mechanism which results in the catastrophic flood of histamine, but they will interfere with the binding of histamine to systemic receptors responsible for the swelling that threatens closure of the airway. Bearing in mind that anaphylaxis varies in speed of onset, then the anti-histamine may well have more time to work in 'delayed' onset cases.

There are other complications such as Kounis syndrome which compound the picture further and Kounis does require treatment with antihistamines and steroids.

 

[user 6228]

on the opposite side why would you have sting and then have no reaction i.e. no local swelling?

 

[itma]

Agreed that anti-histamines are not a substitute for adrenaline but your posting could be interpreted as a recommendation not to take anti-histamines during anaphylaxis and I think on balance that that is not necessarily wise counsel.

Freethorpe Bees described himself as a "fellow allergic person".

If having previously suffered systemic reactions, over-the-counter antihistamines aren't really the best available life insurance.

 

[alanf]

There's a big difference between older generation (systemic) antihistamines and newer generation (peripheral) antihistamines...

I can't recall seeing much detail in the bee writings about anti-histamine use. Most of the sources don't seem to make a lot of distinction and that doesn't seem right. I was told by a more experienced beek that "Piriton" or it's generic equivalent chlorphenamine maleate was the one to use. That tallies with advice from an Australian pharmacist when I got a lot of insect bites in the dunes at night; he supplied "Polaramine", an Australian product with a similar active ingredient. I have found chlorphenamine helps if local swelling and itching are becoming a bit too much, but I haven't tried any alternatives.

Is the pharmacy view that the alternative OTC anti histamines such as cetirizine (Zirtek etc) acrivastine (Benadryl etc) or loratadine (Clarityn) are less (or not) effective for bee stings?

 

[itma]

The distinction I have come across is between 'drowsy' and 'non-drowsy' classes of anti-histamine products.

 

[pbh4]

The distinction I have come across is between 'drowsy' and 'non-drowsy' classes of anti-histamine products.

The docs on my desensitization course recommend taking a ceterizine tablet before the injection to minimize the local symptoms - itching and swelling. They told me it will make no difference at all to anaphylaxis.

Another doctor (the wife!) told me that the "non-drowsy" antihistamines are not very good for itching because the itching sensation is produced in the brain and these drugs do not cross the blood-brain barrier. The ones that do get to the brain, like chlorphenamine, also make you drowsy.

I had my second "maintenance dose" this week - 2 bee stings worth (100 micro grammes) with four weeks in between injections. It still makes me tired but no other symptoms apart from a small itchy swelling at the injection site (a bit like a bee sting really)

Paul

 

[Karol]

I can't recall seeing much detail in the bee writings about anti-histamine use. Most of the sources don't seem to make a lot of distinction and that doesn't seem right. I was told by a more experienced beek that "Piriton" or it's generic equivalent chlorphenamine maleate was the one to use. That tallies with advice from an Australian pharmacist when I got a lot of insect bites in the dunes at night; he supplied "Polaramine", an Australian product with a similar active ingredient. I have found chlorphenamine helps if local swelling and itching are becoming a bit too much, but I haven't tried any alternatives.

Is the pharmacy view that the alternative OTC anti histamines such as cetirizine (Zirtek etc) acrivastine (Benadryl etc) or loratadine (Clarityn) are less (or not) effective for bee stings?

My professional opinion is that the newer generation of antihistamines are not as effective and there are a number of reasons for this.

Chlorpheniramine is not as selective for H1 receptors as the newer generation and also acts on H2 receptors which if stimulated work to 'turn off' allergic reactions. Chlorpheniramine is water soluble whereas the newer generation antihistamines are fat soluble. This means that chlorpheniramine is taken up more quickly. Chlorpheniramine also has antimuscarinic/anticholinergic activity which causes bronchodilation. One of the problems in anaphylaxis is constriction of the airways so anything that helps open up the airways is a benefit. The newer antihistamines don't have this action (to any noticeable degree) as they are highly selective for H1 receptors only. The problem with chlorpheniramine is that it crosses into the brain and causes drowsiness but that's a small price to pay. Chlorpheniramine is not a substitute for adrenaline in anaphylaxis but it is an important adjunct and in the absence of adrenaline (in a first aid situation) could still very well make the difference to someone surviving or not.

 

[freethorpe bees]

Thanks for your thoughts about antihistamines. I had a consultation at Addenbrookes following a reaction to a beesting and subsequent RAST test. Alas the desensitising course is not possible, Addenbrookes is too far and with work commitments getting there once a week I just couldn't do it. The doctor recommended taking two ceterizine if I am stung. Then if need be use the epipen. My reaction was systemic but took an hour before I knew anything was wrong.
Interesting to hear the different advice and thoughts you all have.