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Karol

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Thought I'd open this thread because there appears to be some confusion about the mechanism of bee sting envenomation.

The perceived wisdom is that Kounis syndrome (allergically mediated heart attacks) is a rare event only associated with anaphylaxis and it is a wisdom that I question.

This is where things get a bit technical - sorry!

Kounis syndrome happens when immune system cells called mast cells release their 'payload' chemicals. This can happen during anaphylaxis. In anaphylaxis allergy causing chemicals in bee venom (allergens) stimulate 'Y' shaped IgE antibodies that are found coating the surface of the mast cell. If enough IgE antibodies are stimulated it causes a chain reaction in the mast cell causing it to release its payload chemicals. The release of these payload chemicals can cause blood vessels supplying the heart to constrict or block leading to a heart attack.

The above is the perceived wisdom and explains how Kounis can occur during anaphylaxis. However, it is only part of the story.

Mast cells also have 'gateways' in their cell walls. These are called G-proteins. Certain components of bee venom including mast cell de-granulating peptides target these gateways by-passing the IgE system entirely. When the G-proteins are activated they cause the same reaction in the mast cell, i.e. they cause the mast cell to release its payload of chemicals. However, this happens at much lower concentrations and does not need to be linked to anaphylaxis so Kounis can occur without the symptoms of anaphylaxis.

The difficulty understanding bee stings is that medically the 'allergic' side of things is dealt with by a different group of medical specialists to those that would be interested in Kounis without anaphylaxis.

What the significance of all this is to bee keepers is hard to understand and may or may not amount to much save that it may help explain why reactions may be worse for bee keepers on certain medication.

One thing I would say though is that it would suggest that bee keepers would be expected to be more prone to heart attacks as a population. Whether that it true or not is conflated by whether or not living a gentile outdoor lifestyle means that bee keepers as a population naturally have healthier hearts and are therefore less prone to the effects of Kounis but also because repeated bee stings may actually help down regulate the number of G-protein gateways on mast cells thereby giving bee keepers a degree of immunity against Kounis.
 
Thought I'd open this thread because there appears to be some confusion about the mechanism of bee sting envenomation.

The perceived wisdom is that Kounis syndrome (allergically mediated heart attacks) is a rare event only associated with anaphylaxis and it is a wisdom that I question.

This is where things get a bit technical - sorry!

Kounis syndrome happens when immune system cells called mast cells release their 'payload' chemicals. This can happen during anaphylaxis. In anaphylaxis allergy causing chemicals in bee venom (allergens) stimulate 'Y' shaped IgE antibodies that are found coating the surface of the mast cell. If enough IgE antibodies are stimulated it causes a chain reaction in the mast cell causing it to release its payload chemicals. The release of these payload chemicals can cause blood vessels supplying the heart to constrict or block leading to a heart attack.

The above is the perceived wisdom and explains how Kounis can occur during anaphylaxis. However, it is only part of the story.

Mast cells also have 'gateways' in their cell walls. These are called G-proteins. Certain components of bee venom including mast cell de-granulating peptides target these gateways by-passing the IgE system entirely. When the G-proteins are activated they cause the same reaction in the mast cell, i.e. they cause the mast cell to release its payload of chemicals. However, this happens at much lower concentrations and does not need to be linked to anaphylaxis so Kounis can occur without the symptoms of anaphylaxis.

The difficulty understanding bee stings is that medically the 'allergic' side of things is dealt with by a different group of medical specialists to those that would be interested in Kounis without anaphylaxis.

What the significance of all this is to bee keepers is hard to understand and may or may not amount to much save that it may help explain why reactions may be worse for bee keepers on certain medication.

One thing I would say though is that it would suggest that bee keepers would be expected to be more prone to heart attacks as a population. Whether that it true or not is conflated by whether or not living a gentile outdoor lifestyle means that bee keepers as a population naturally have healthier hearts and are therefore less prone to the effects of Kounis but also because repeated bee stings may actually help down regulate the number of G-protein gateways on mast cells thereby giving bee keepers a degree of immunity against Kounis.

Interesting post Karol. It creates more questions than it gives answers but I suppose the main one is "what do we do about it" beyond avoiding unnecessary stinging situations and maybe communicating the message to medical staff in A&E in the event of "an incident"?
 
I think it is difficult to know what advice to give other than get periodic health checks to make sure the ol' ticker is OK and try to stay in good shape so as to limit the amount of furring of arteries as atheroscleroma appears to be the biggest underlying risk factor.

As for avoiding stings then I don't know which way to go on that one. There is an argument that a lower frequency of stings might reduce the level of immunity and actually increase risk?
 
Interesting post Karol. It creates more questions than it gives answers but I suppose the main one is "what do we do about it" beyond avoiding unnecessary stinging situations and maybe communicating the message to medical staff in A&E in the event of "an incident"?

I agree that it asks more questions than it potentially answers. I'm not suggesting that bee keepers change their bee keeping habits save not to take unnecessary risks around wasps. The reason being that frequent repeated honey bee stings may actually have a protective effect which is something that is never likely to be experienced with periodic wasp stings where infrequency of stings is more likely to give rise to allergic reactions.

As with my previous post there is a lot to be said for maintaining a healthy life style. Smoking significantly increases the risk of atherscleroma as does a life of fatty cooked breakfasts and obesity. Don't tend to see many obese bee keepers probably because bee keeping requires participation by relatively fit individuals so Kounis may be something that is regularly encountered by bee keepers but their natural level of fitness as a population means that the symptoms go largely unnoticed.

I have posted previously about what to do in the event of possible Kounis complications of stings and the precautions to be taken (chlorpheniramine tablets etc etc) so don't really want to re-hash previous threads. I do think it is very worth while mentioning Kounis if you have to go to A&E as a consequence of a sting and I do think it's worth keeping in mind that Kounis induced coronary problems can be delayed by several days if not more.
 

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