Bee sting desensitisation course

[dpearce4]

I don't get a problem with bee stings and I'v only ever been stung twice in my life, I don't know why ? but horse flies love me and my arms swell up like pumpkins and the only thing that stops them itching is a tool called a insect bit zapper, it gives a little high current spark much like an electronic lighter, give it a few clicks and the itching stops for a while, worth a go

I dont have a problem with horseflys or mozzies. My wife hates it when we go away, she gets bitten to hell and they come up like my beestings whereas they leave me alone. she sees this as karma haha.

 

[Karol]

I don't get a problem with bee stings and I'v only ever been stung twice in my life, I don't know why ? but horse flies love me and my arms swell up like pumpkins and the only thing that stops them itching is a tool called a insect bit zapper, it gives a little high current spark much like an electronic lighter, give it a few clicks and the itching stops for a while, worth a go

It might be worth a go in any other situation but I don't think it's a good idea to zap a desensitisation injection site.

Just a little note of caution:

The principle behind the zapper (and I have to say I'm very dubious about the claims made) is that the localised heat/current that is generated breaks down venom proteins which reduces symptoms. If this is true then there is a risk that using such a device might undermine the desensitisation process possibly leading it to fail? Afterall, the purpose of the desensitisation process is to expose the body to these toxins so what's the point of trying to break them down?

 

[REDWOOD]

Yes i see what you mean just thought it would be better than scratching it which could lead to infection. I got stung by a jellyfish once whilst fishing and poured my very hot coffee over it and surprised how quick it worked

 

[dpearce4]

waste of good coffee

 

[Drew]

Yes i see what you mean just thought it would be better than scratching it which could lead to infection. I got stung by a jellyfish once whilst fishing and poured my very hot coffee over it and surprised how quick it worked

waste of good coffee

I thought the jelly fish sting cure was to piss on it....... I guess coffee smells better!

 

[Karol]

Yes i see what you mean just thought it would be better than scratching it which could lead to infection. I got stung by a jellyfish once whilst fishing and poured my very hot coffee over it and surprised how quick it worked

If the itch is a real problem topically then you could try 1% Hydrocortisone cream which should also help with any swelling. Worth just checking with the clinic that it won't cause a problem but I can't think of any reason why it should.

 

[dpearce4]

Week 7

Due to the reaction to my injection last week it was decided by myself and the doc to keep me on the same dose today. The weekly injections will still carry on for another 7weeks or more if i react badly again.

Today a small reaction, arm looks like i have been bitten by a mozzie, small lump and itching. Will be interesting to see what its like tomorrow.

I also spoke to them about Pain killers due to my back being bad at the moment and i was told that Co dyhrdamol (sp) and Tramadol should not cause any adverse reaction to bee stings. This is good news to me as i have been missing them for the last week or so (no im not addicted lol), just been working at a very low level which has caused quite alot of pain.

 

[itma]

Due to the reaction to my injection last week it was decided by myself and the doc to keep me on the same dose today. ...

Today a small reaction, arm looks like i have been bitten by a mozzie, small lump and itching. Will be interesting to see what its like tomorrow.

Hey, that's great!

Last week this same dose was giving you "systemic" effects - away from the injection.
You were getting strange tastes, feeling light-headed, feeling wobbly, knackered and detached from what you were saying.
Not this week from the sound of it!
Here's to the progress!

 

[BeeJayBee]

Here's to the progress!

 

[REDWOOD]

Well done, how are you feeling in your self

 

[goodbobby]

desensisation

Hi dpearce4,

I have watched this thread with interest since you started.. I also suffer from bad reactions to bee stings and two years ago went privately to see a Senior Consultant in Immunology and Allergy . Over 3 consultations he did loads of tests, confirmed that I had a very high reaction level to bee venom RAST 76.0 (much higher than to wasp venom RAST 4.30) and basically recommended that I give up beekeeping.

When I said that I wanted to try and carry on he gave me prescriptions for an epipen and low dose prednisolone for severe swellings and lectured me very thoroughly about their use and my risk levels. I asked him about a desensitisation course and he was very disparaging saying that success levels were poor and quite long courses of booster injections would be required year in year out. Given his obvious knowledge on such matters I took his guidance as gospel and bought a much better quality suit and gloves plus tightened up my inspection methodology considerably.....as a result I have avoided any major stings for 2 seasons (currently running 6 colonies) and am comfortable with my safety and risk levels.

My query,given this thread, is what advice have you received from your clinician about success probabilities and also your future regime? My guy told me that immunity builds during the season as you are stung/ nicked and then fades away pretty well completely during the winter......just curious???????

 

[dpearce4]

Hi Goodbobby,

One reason the consultant may have given you that suggestion not to go down the route of immunotheropy is the cost, as you say you went to him privately the cost may have fallen onto you or your private medical insurance supplier, as far as i am aware the cost for the 3years runs to about £13k which is a massive amount.

Now as far as i am aware the NHS would not waste this sort of money on something that does not work. But also the consultant i have been seeing has stated that the effectiveness is 93%+, it takes a total of 3 years to go through the whole course. starting weekly for 12weeks(or more if you react badly or have to take a week off, in my case now 14weeks) as they build up to a total of 2 stings, then monthly for a year, continuing through the winter so no loss of effectiveness, then finally every 6weeks until the end.

If they find you are still reacting at the 2sting level badly they can then increase you upto double that, but that has to be done very carefully for obvious reasons.

I have found that depending on where you are depends on what advice you get and not all of it is good. My consultant did not even consider asking me to give up as he has said he sees lots of beeks and they are always very pragmatic about the stings and as long as you are careful (which you seem to be) the risks can be reduced.

I wouldnt bother going back to the guy privately, but i would really urge you to go back to your GP and demand the course of treatment, he has to give you a referral even if he dont want to. I would say it really takes strong will to go through it, it isnt easy but I feel at the end i will be much better off having been thro it.

For you you would probly end up going upto london for yours or down to brighton as its not done in most hospitals. But go for it dont take the docs word, it really is worth it.

I hope this makes sense.

If you want to talk to him the Consultant im under is Prof Anthony Frew you can contact him through the attached page and maybe have a chat with him.

http://www.bsuh.nhs.uk/departments/consultant-directory/?entryid156=298985&q=0~allergy~

He is very good.

 

[dpearce4]

Week 7 update

My arm is itching quite alot today, its not very swollen but the area of where i was injected yesterday is very hot.

 

[pbh4]

Hi Goodbobby,

One reason the consultant may have given you that suggestion not to go down the route of immunotheropy is the cost, as you say you went to him privately the cost may have fallen onto you or your private medical insurance supplier, as far as i am aware the cost for the 3years runs to about £13k which is a massive amount.

Wow, I knew it must be expensive - 50 outpatients appointments - but I have never heard an actual figure.

Now as far as i am aware the NHS would not waste this sort of money on something that does not work. But also the consultant i have been seeing has stated that the effectiveness is 93%+, it takes a total of 3 years to go through the whole course. starting weekly for 12 weeks(or more if you react badly or have to take a week off, in my case now 14weeks) as they build up to a total of 2 stings, then monthly for a year, continuing through the winter so no loss of effectiveness, then finally every 6weeks until the end.

I have spoken to my doctors and also read as much of the research literature as I can find and the success of the venom immunotherapy (VIT) is commonly quoted as greater than 90%. My medics say I will not need to carry an epi-pen at the end of the treatment. They aim to cure me.

However, I am not sure the case has been made in terms of cost effectiveness. There is a NICE report (I can dig out the reference if anyone is interested) that calculates the cost of a VIT QALY as £2 million (if I remember correctly). A QALY is a quality-adjusted life year so might mean one fit, healty person living an extra year or someone else living a couple of years with a degree of disability - bizarre, but that is how they work it out! Anyway, the NICE (is it NIHCE now?) guidelines are that any treatment that costs more than about $20000 per QALY is too expensive. VIT is 100 times that. The reason for the high price is that it saves few lives because, even with a real allergy, it is pretty rare for bee stings to kill so the treatment saves few. It has a positive impact on the quality of life of many patients for many years and that counts for something in pricing the QALY.

Keep quiet about all that by the way - at least until I have finished my treatment!

I have found that depending on where you are depends on what advice you get and not all of it is good. My consultant did not even consider asking me to give up as he has said he sees lots of beeks and they are always very pragmatic about the stings and as long as you are careful (which you seem to be) the risks can be reduced.

I agree about the variable quality of advice. I have been lucky in Leicester, I think. (If only the ambulance service had a clue about anaphylaxis!) Your consultant seems to have a sensible, pragmatic attitude to beekeepers.

I wouldnt bother going back to the guy privately, but i would really urge you to go back to your GP and demand the course of treatment, he has to give you a referral even if he dont want to. I would say it really takes strong will to go through it, it isnt easy but I feel at the end i will be much better off having been thro it.

Good idea to see the GP. You are entitled to a second opinion on the NHS but I am not sure (s)he has to refer you to a consultant - they have to exercise professional judgement. Best to ask nicely rather than demand

Paul

 

[goodbobby]

desensitisation

Hi dpearce4

Playing the devil's advocate, I wonder whether his having to fund a private nurse for vaccinations would just not be efficacious (cost-wise) use of this particular Consultants private practice time and thus his reticence...... I am very lucky that I have lifetime private medical cover from a previous employer so cost is not an issue but this consultants reaction to my enquiry about the VIT process was very dismissive indeed.Therefore, I would almost certainly have to seek another private clinician!

On the other hand, I have already discussed desensitisation with my GP and an NHS referral would, in theory, not be a problem. However, my SWMBO (who runs a large GP practice) tells me that when NHS PCTs (Primary Care Trusts) undergo the planned massive changes due this April, funding of this type of treatment and £amount will be only available in very exceptional circumstances! So this avenue is likely to be closed to most of us fairly soon!

On balance, I think I will just stick with my good equipment, good practices and good husbandry "approach" for the time-being as this seems to be working well. However, I do hope you continue your interesting thread into this coming season, letting us know how successful the course of treatment has been.

 

[Karol]

I think desensitisation is actually a bit like trying to navigate through a mine field.

Medical opinion will be split on this and justifiably so and not just because of cost. Undergoing desensitisation has its risks which are not insignificant. It is for medical experts to weigh up the benefits and risks of therapy for each individual and importantly to assess whether the individual will survive the treatment let alone get any real benefit from it.

It's not just the risk of anaphylaxis that medics have to consider. There are other complications as well. All of which has to be balanced against the potential benefit. And what is that benefit?

A reduced likelihood of reacting? Probably but not absolutely?

In practical terms should it result in taking fewer precautions? Absolutely not. There are so many co-factors that it's impossible to predict whether the desensitisation treatment has been successful. The best that the treatment can achieve is desensitisation to the venom that's been used during treatment with a hope and a prayer that it will cover the venom that's actually encountered in the field. Desensitisation is a means of risk reduction but it's not going to remove risk beyond an 'appreciable' level. What does 90%efficacy mean in this context? One won't react to 9 out of 10 stings? Or 9 out of 10 people won't suffer anaphylaxis the next time that they are stung? Is that enough risk reduction to avoid taking all necessary precautions not to get stung in the future?

I'd be interested to see the QALY data. QALYs can be notoriously ambiguous if their context is not clarified. It's quite right that the number of people dying from bee sting anaphylaxis is relatively small but this is partly because A&E services are so good in rescuing patients in so many cases using comparatively inexpensive drugs that cost little more than a few pennies. Improvement in quality of life in bee sting allergies is an interesting concept as it must assume that bee keepers continue to be exposed to risk and continue to get stung - which kinda indicates that 'patients' aren't doing enough to protect themselves from risk and are perhaps taking a cavalier approach to that risk as a consequence of having the therapy?

Ok, continuing to be controversial: Bee keeping is a hobby for most. Why should bee keepers expect tax payers to pay large sums of money for desensitisation so that they can feel safer about continuing with their hobby? NHS budgets are stretched to the limit. So what gives instead? Funding for a child with brain cancer? The closure of Lewisham? If bee keeping is a hobby, and therefore an elected activity, shouldn't desensitisation be paid for privately?

A veritable mine field and sadly one of the reasons why I don't keep bees.

 

[alldigging]

During the course of desensitisation, what happens if you get stung? Does that throw their plans out?

 

[itma]

.. I asked {the private medical consultant} about a desensitisation course and he was very disparaging saying that success levels were poor and quite long courses of booster injections would be required year in year out. Given his obvious knowledge on such matters I took his guidance as gospel and bought a much better quality suit and gloves plus tightened up my inspection methodology considerably.....as a result I have avoided any major stings for 2 seasons (currently running 6 colonies) and am comfortable with my safety and risk levels.
...

...
On balance, I think I will just stick with my good equipment, good practices and good husbandry "approach" for the time-being as this seems to be working well. ... .

Point 1 -- it is factually not true that for maintaining desensitisation (after the three year programme is completed) "quite long courses of booster injections would be required year in year out".
Either you have misunderstood him, or misrepresented his comment, or he has mislead you on that specific point.

Point 2 -- The impression I take from the bolded section is that you are using thick leather gloves, which is the very opposite of the conventional beekeeping wisdom, when it comes to *avoiding* stings.
Certainly, techniques like using an inspection cloth will do no harm to your safety-first effort, but thicker gloves are usually counter-productive.

Point 3 -- If you are at risk of a serious systemic reaction - and for whatever reason do not wish to attempt a desensitisation course, one important aspect for attention - not mentioned anywhere in your posts - would be to invest in the calmest, gentlest bees that you can possibly find.
While that wouldn't protect you from other folk's bees, I think it is a better approach than thicker gloves!

 

[pbh4]

I
I'd be interested to see the QALY data. QALYs can be notoriously ambiguous if their context is not clarified. It's quite right that the number of people dying from bee sting anaphylaxis is relatively small but this is partly because A&E services are so good in rescuing patients in so many cases using comparatively inexpensive drugs that cost little more than a few pennies. Improvement in quality of life in bee sting allergies is an interesting concept as it must assume that bee keepers continue to be exposed to risk and continue to get stung - which kinda indicates that 'patients' aren't doing enough to protect themselves from risk and are perhaps taking a cavalier approach to that risk as a consequence of having the therapy?

www.nice.org.uk/nicemedia/live/13671/58194/58194.pdf

Just considering deaths prevented: "£18,070,000 per QALY gained compared with an adrenaline auto-injector plus high-dose antihistamine and advice."

Taking into consideration quality of life: "The Committee noted that in these analyses the ICER for Pharmalgen decreased to less than £30,000 per QALY gained. "

Looking at the long term benefits over > 10 years: "with reduced anxiety about re-stings after treatment with Pharmalgen the most plausible ICER would be less than £20,000 per QALY gained."

Conclusion: "The Committee concluded that Pharmalgen is an appropriate use of NHS resources for people with IgE-mediated allergy to bee and wasp venom, who have a high risk of stings."

 

[oxnatbees]

Venom desensitisation

I'm on bee venom desensitisation at the Oxford Radcliffe hospital.

You MUST tell the doctors about that reaction so they can gauge how often you react, it may affect the dosage regime they give you, they will know to keep an especially close eye on you. I don't know how they are organised at your clinic, but at Oxford the way they operate is, you hang around for say an hour after your injection. (Exactly how long depends how far through the course you are.) That's so if you have a reaction, the doctors can watch you like a hawk and treat you immediately if your airway begins closing up. A couple of times now, after a few months of going, I've seen the doctors cluster round someone, take them to the bed in the corner, pull the curtains round it for privacy and that person was kept in for a couple of extra hours. The sufferer felt pretty rough. Don't worry about embarassment etc, that's their job, and all other patients there are present because they've all had a systemic reaction and will understand.

One other point about venom treatments. This costs the NHS, I've heard, something like £20,000 per patient. So if you reckon you're "cured" after 2 years, and it's a bit tedious going along every 6 weeks for another 3 years... DON'T drop out as so many do. Big waste of taxpayers' (i.e. your) money.

No idea about the pepper taste!