Bee stings & Benadryl

[Pat]

More and more often, closer and closer to home......
it's no longer as distant as it once was.

- Motorcycle riders' (bad) reaction to bee stings -

I was on a ride with a group of riders, two of us at the back of the pack on an isolated road, suddenly the guy in front of me pulls over and whips his helmet off. Bee sting. I offered him one of my Gold Bond medicated wet wipes, and it afforded him at least some relief. He didn't have a bad reaction, but I've heard that some people do and watched him closely before boarding the bikes. When I told this story to a buddy recently, he reached over for his "pen" (or whatever he called it) and explained that he goes nowhere without this needle with which to stab himself in the event he gets stung by a bee. He also told me, to my GREAT surprise.... that one doesn't have to have a history of reacting poorly to bee stings, it can happen to ANYBODY at ANYTIME!

So I wanna know from any Doktors in zu Hause 'bout that over-the-counter Benadryl stuff, and if it's good stuff to have around on a ride, how much in the event of, and when NOT to use some Benadryl.

It was only a couple weeks ago that I saw a guy go into, come out of, and then go deeper into shock; an ambulance came to take him away. He got stung by a bee on a bike ride.....

Either I'm out more often, or I'm around more folks getting stung......

What to do? Is Benadryl a good temp' fix or early intervention? What do I/we need to know????

[Just-Beeming]

Pat
I'm a nurse. I give lots of drugs that people can react to.
Bee stings are not that different from drug reactions. As a reaction is a reaction.
As a general rule, one of the first measures most docs will prescribe is benadryl 50 mg and tylenol 650 mg for almost any reaction.
If people know they have an allergy they should carry a bee sting kit, which I believe consists of tylenol, benadryl, and an epi pen. (injectable epinephrine...which people used to all call adrenalin)
Keep in mind the benadryl has side effects as anyone who has ever taken tylenol PM can attest to...It (in two tabs)is the same exact formula as described above. It can make you really sleepy and for a few unfortunates it can give them nervous, wiggling legs. So riding for that individual should be over for 6 hours.

I am not certain if a steroid like hydrocortisone, prednisone or solumedrol would be effective but my hunch is that it would... the problem is that these injectable forms as well as pill form require prescription. An inhaler of albuterol like asthmatics use might be helpful as well...if breathing becomes a problem.

So long answer to your question is ...yes, I would offer an individual tylenol and benadryl to prevent a reaction,,,,but his/her riding should be over for the rest of the afternoon.

Any Doc's out there have any opinions?

Just Beeming

[xaque]

Good questions!

How about a crash course in the subject... shall we?

Firstly, Benadryl and the "pen" of epinephrine (EpiPen) work in two different ways. To better understand their actions, lets review the reaction a body has to a bee sting.

In it's most basic form, an allergic reaction is when one type of cell in the body (mast cell) releases a substance that another "receptor" cell picks up. When this process occurs, the body will swell, and the nose will run, and the eyes will water, etc.

The extent of the reaction is based on the extent of those cells interacting.

For your "average joe" bee sting, the number of mast cells that release is controlled and limited. You get a localized swelling, and discomfort, but that is it.

When someone has a very bad reaction, also known as "Anaphylaxis," the release of the mast cells goes way out of control. Instead of this process stopping at a reasonable place, it continues until the symptoms effect the person's ability to breathe and circulate blood.

Now that we have a back ground, let’s talk about how the various medications work!

Benadryl works by blocking the "receptor" cells. The mast cell is still releasing the substance, but the other cells can't pick it up. This drug is fantastic for your smaller, run-of-the-mill reactions. The mast cells eventually stop on their own, so all the benadryl needs to do is block the receptors to stop the allergy symptoms. (This is why one may take it for hay-fever. If they are being constantly exposed to pollen, the benadryl will limit the bodies ability to react to it.)

EpiPen's work by stopping the mast cells from releasing in the first place. This is very useful when the allergic reaction becomes out of control and will not stop at a reasonable place on its own. This process is what saves people's lives when they are in Anaphylaxis, but is totally unnecessary for your every day allergies. (Epinephrine does some other really cool and helpful stuff, but for our purposes I'll keep this simple). One is advised to hold off the use of the EpiPen until the patient is having a severe difficulty breathing and can no longer get an adequate amount of air in with each breath. (EpiPens look like a large magic marker, with a very large needle in it. It is jammed into the thigh and the epinephrine is automaticaly injected in the body.)

The use of a topical steroidal drug will help reduce the swelling or itching in the immediate area of a sting, but will not help control an overall severe allergic reaction. The patient may choose to use a cream to relieve discomfort in the area of a bee sting.

If the patient is prescribed an Albuterol Inhaler or equivilant (such as for Asthma) than it should certainly be used if the patient feels that they need to. Albuterol's side effects are a lot like the effects of the EpiPen (Beta 2 adrenergic), but I would not consider the use of it for the control of an allergic reaction in general without the presence of Asthma symptoms.

Okay, now with all that said... who should carry the EpiPens?

People who are generally prescribed EpiPens have a known severe allergy to Bees, peanuts, etc. Their allergies either result in anaphylaxis, or have been so bad in the past the fear is that it may someday result in anaphylaxis. The average person will not need to carry an EpiPen around (I have heard of exceptions being made for individuals in a high risk environment, such as Bee Keepers).

How does one know if they will have an Anaphylactic reaction?

Well... someone needs to be introduced to an offending substance (bee, peanut, etc) at least once before they can have a severe allergic reaction. An example would be a person who is stung once by a bee, and has a very minor, localized reaction, but the second time it results in anaphylaxis.

This means that the very first time someone is stung by a bee, they will not have a severe allergic reaction. If you have only been stung by a bee once in your life, you can not say for sure that you are not severely allergic. For people who do have severe allergies, each subsequent allergic reaction is usually worse than the previous one. (Other factors, such as allergies to certain other substances, or a family history of a severe allergy may be a warning sign of a potential severe allergy)

Carrying benadryl with you is not a bad idea, if given early it may be enough to stop a larger reaction, or in the very least, lesson the discomfort from a bee sting. As said by our lovely nurse above, one should consider the side effects of any medication, especially while riding a motorcycle. I would also add that one should be careful if giving medication to others (in that the other person is not aware of any personal allergy to the medication, potential interaction with a medication they are already taking, etc).

I think that about sums it up… anyone else care to chime in?

(It is very late here, so if I have misspoke, please let me know!)

-Xaque-

[SLEDGE]

Very well said xaque. May I add that if the reaction is very bad, I'm talking about Anaphlaxis(a life thritting condition) one would want to ch the pt's B/P befor giving Benadryl and if low not give it. epi would be the choise.A call for the rescue squad would be indicated. My $0.02

[leno]

So nothing realy to do with bikes but very intresting none the less. Thanks for the intresting little lecture.

[R4R&R]

Thanks Xague - great explanation! It really helps to understand what you are dealing with in unique situations and you did a good job explaining that. Having this knowlege may someday save someone.

Thanks again!

[mnnden]

I have been stung a couple of times on the bike so this topic is of interest to me, Xague, Great information!! I am going to go back and read it again, Thanks. Den

[bgardner74]

Beestly topic. To add my experiences, two to be exact, I got my first bee sting in my fifties. On my left thumb. Within a few minutes, the thumb had swollen to near twice its normal size and felt as it were afire. Got into the car and drove to my doctor's office. Everyone was out to lunch. So I waited, not knowing what the implications were. The swelling and pain increased. An hour later, I had been given a shot and an epi pen prescription along with the advice that should it happen again, take two Benadryl at once. And either use the pen or go to the emergency room.

If you're waiting for a motorcycle connection, thankfully, there is none. Ten years later, last September to exact, while mowing the lawn on a riding mower, I came too close to a raised planting bed and a swarm of angry yellow jackets emerged and attacked. 7 stings in a few seconds. Face, neck, arms. Instantly painful. I had never gotten the epi pen prescription filled. So I took two Benadryl and drove 15 miles to the nearest emergency room. On a gurney in an exam room, a paramedic removed the visible stingers. The Benadryl took effect and I fell asleep for 2 hours. Frankly, had the same attack happened while on the bike, not sure I could have come to a controlled stop and dismounted without dropping it or me.

When I awoke, the emergency room doctor wrote another epi pen prescription, which was filled on my way home. Benadryl works and works promptly but can leave you in no condition to operate anything with a motor. Some people get stung, it hurts and it's over. I learned that if you have an allergic reaction, it will likely be worse with each subsequent sting. The negative results are cumulative.

Be prepared, carry a couple of pills with you. And an epi pen if you have reason for concern.

[rph802]

Beestly topic. To add my experiences, two to be exact, I got my first bee sting in my fifties. On my left thumb. Within a few minutes, the thumb had swollen to near twice its normal size and felt as it were afire. Got into the car and drove to my doctor's office. Everyone was out to lunch. So I waited, not knowing what the implications were. The swelling and pain increased. An hour later, I had been given a shot and an epi pen prescription along with the advice that should it happen again, take two Benadryl at once. And either use the pen or go to the emergency room.

If you're waiting for a motorcycle connection, thankfully, there is none. Ten years later, last September to exact, while mowing the lawn on a riding mower, I came too close to a raised planting bed and a swarm of angry yellow jackets emerged and attacked. 7 stings in a few seconds. Face, neck, arms. Instantly painful. I had never gotten the epi pen prescription filled. So I took two Benadryl and drove 15 miles to the nearest emergency room. On a gurney in an exam room, a paramedic removed the visible stingers. The Benadryl took effect and I fell asleep for 2 hours. Frankly, had the same attack happened while on the bike, not sure I could have come to a controlled stop and dismounted without dropping it or me.

When I awoke, the emergency room doctor wrote another epi pen prescription, which was filled on my way home. Benadryl works and works promptly but can leave you in no condition to operate anything with a motor. Some people get stung, it hurts and it's over. I learned that if you have an allergic reaction, it will likely be worse with each subsequent sting. The negative results are cumulative.

Be prepared, carry a couple of pills with you. And an epi pen if you have reason for concern.

Nothing with a motor or feet for that matter!!

I have to laugh out loud at the benadryl commercial saying its just as effective " as the other leading brands". If you read the fine print, the dose studied was 50mg (2 pills) three times a day. Sure the patients didnt report any symptoms because they were in a coma!!!! As a pharmacist I just want to strangle the folks in the benadryl marketing dept!!

One thing on the epi pens, ask for the 2 pack of pens. this way you have a back up in case its needed to repeat the dose (if you are far away from medical help but only if advised by a doc). Also keep an eye on the expiration dates. Mostly likely they'll be good for a couple years if stored properly but I'd suggest getting new ones if the expiration date is coming up in the next 6 months. This isnt something you wanna let go bad if you need it!!!

[Brakecheck]

I'm allergic to bee stings and have have lived with the problem for about forty years now. After nearly dying from a sting when I was about eight or nine I went through a Desensitization procedure for several months where I went to the doc twice a week for injections. Not sure if they still do it this way. Anyway, I still carry an epi pen and have used it twice in just the last five years or so. Both times I was stung by wasps while working in the horse stable. My reaction to stings seems to have moderated a bit with age but I still head to a medical facility after I inject myself because you just never know how you will react to whatever stung you. Just picture yourself covered head to toe with Raised red Welts on your skin, desparately trying to suck air into your lungs as you make a bee-line (pun intended) to the E.R.

THIS IS A SERIOUS TOPIC!

If someone is stung, ask them "have you ever been stung before?" Watch for skin rashes and/or welts appearing anywhere on their body other than the sting site. Monitor breathing. If you have the slightest suspicion things don't look or sound right...Get them to the doctor ASAP! I mean haul A$$! After the sting, things can go south in a hurry as the individual's throat swells up, and breathing becomes more and more restricted if not impossible. Always err on the side of caution with this because it may take awhile to get to the hospital. Oh yeah, it wouldn't hurt to brush up on your roadside Tracheotomy technique either...

One last thing. i appreciate the post made by Xaque however, I do not agree with this:

"Well... someone needs to be introduced to an offending substance (bee, peanut, etc) at least once before they can have a severe allergic reaction."

or this

"This means that the very first time someone is stung by a bee, they will not have a severe allergic reaction."

This was not the case when I was first stung, nor the case a few years ago when we first fed my then baby son his first eggs. Five minutes after he ate it we were off to the E.R. That is why you are supposed to wait until the appropriate age and then must watch the child when you feed it a new food for the first time. I won't say the information is wrong...I'm not a Doc or even an EMT, it just doesn't agree with my practical experience.

Ride Safe everyone, Dana

[xaque]

...One last thing. i appreciate the post made by Xaque however, I do not agree with this:

"Well... someone needs to be introduced to an offending substance (bee, peanut, etc) at least once before they can have a severe allergic reaction."

or this

"This means that the very first time someone is stung by a bee, they will not have a severe allergic reaction."

This was not the case when I was first stung, nor the case a few years ago when we first fed my then baby son his first eggs. Five minutes after he ate it we were off to the E.R....

Ride Safe everyone, Dana

Let me clearify.

Let's look at Antigens and Antibodies. Antigens are the things that can cause the body to have a reaction. An Antibody is what the body creates to fight the antigen.

Say I eat a peanut for the first time in my life. My body will not recognize the substance and will decided how to handle it. If my body doesn't like the peanut then it was cause my to vomit, or poop to get rid of it. My body will then develope an Antibody for peanuts. The next time I eat a peanut, my body will recognize it and use the appropriate antibody to take care of it.

The problem arrises when the body does not create the appropriate antibody, or fails to create any. The second time I eat a peanut, my body recognizes it as bad, but does not have an antibody for it. In response my body throws everything it's got at it in an attempt rid myself of the damn peanut.

In response to your experience, your child would have had to been exposed to Eggs (the antigen) at least once for him to have the severe reaction the second time. This is not so far fetched as egg can be found in almost anything. (Even if something was prepared on the same surface as an egg, that can do it. All you need is a very small amount of the egg protien present)

Often people are exposed to the antigen orriginaly, and have no idea. (Could your child have touched a surface that a scrambled egg may have touched?)

If someone does use their EpiPen they should most certainly seek medical attention as soon as possible. Not just because the reaction may continue, but the side effects of the EpiPen can cause problems. I would also encourage people to dial 911 instead of driving themselves or having someone else drive.

-Xaque-

[Brakecheck]

Xaque, I did a little research and this is what I came up with.

The causes of anaphylaxis are divided into two major groups:

IgE mediated: This form is the true anaphylaxis that requires an initial sensitizing exposure, the coating of the mast cells and basophils by IgE, and the explosive release of chemical mediators upon re-exposure.

Non-IgE mediated: These reactions, the so called "anaphylactoid" reactions, are similar to those of true anaphylaxis, but do not require an IgE immune reaction. They are usually caused by the direct stimulation of the mast cells and basophils. The same mediators as occur with true anaphylaxis are released and the same effects are produced. This reaction can happen, and often does, on initial as well as subsequent exposures, since no sensitization is required.

The terms anaphylaxis and anaphylactoid (meaning "like anaphylaxis") are both used to describe this severe, allergic reaction. Anaphylaxis is used to describe reactions that are initiated by IgE and anaphylactoid is used in reference to reactions that are not caused by IgE. The effects of the reactions are the same, however, and are generally treated in the same manner.


Interesting stuff.

[Rog(UK) - Yorkshire Dales]

I may have missed something here, but what's IgE please?

Very interesting topic.

Rog.

[Dr. Strangelove]

All right

IgE is immunoglobulin E a mediator of the allergic reaction

If someone is having a severe reaction--anaphylaxis--they look like they are going into shock because they are. Their Bp will be falling, their pulse rate will probably get fast --ie > 100-120, though in some circumstances might get slow. They will have troublew maintaining consciousness, they might get nauseated. It is a severe reaction and is not subtle. They might have trouble breathing, "throat closing up", mght be wheezing, might be going into heart failure. They very could look like they're going to die, as well they might.
There is one treatment and that is epinephrine. Give the whole syringe--probably 1 mg-- and it might have to be repeated. A 911 call is necessary. Steroids would not hurt, benedryl would not hurt, but the treatment is epiniphrine given asap--into the thigh, through the clothing.

If this is a mild or slowly progressing reaction--local in nature, ie redness, swelling, pain at the bite site--benedryl (25-50 mg by mouth) will probably help, steroids--eg injection IM of celestone (6mg) or IV decadron (dexamethasone) 8 mg.
Ice on the site will probably help also.


Short answer:
a severe reaction is possible and it can occur very quickly. it is a true medical emergency. if anaphylaxis is occuring the treatment is epinephrine. Call 911. give epi if you have it.
For a local reaction benedryl (and the other antihistamines), steroids, ice will help.

Be aware that many of the antihistamines will make you sleepy and you should not ride with them on board--probably up to 24 hours.

John

[Wayno28]

Ok I read this very quickly but my understanding is that a person
can, have been stung several times in their life and even tho
they always just had localized reactions the anaphylaxis shock
could still hit them the next time they are stung.
JUst because you have been stung many times does not mean you
will not have probs the next time.

I hope that made since

[Pat]

Cool,

so a Gold Bond Medicated wet wipe AND a Benadryl may be in order.
Thanks.

I carry a little hand-held siphon for Sportsters along-side the road out of gas, a little electric compressor for VW trikes with an air suspension (and a leak), my tire plugger kit for folks with flats, bottles of water for those about to succumb to heat, and dry cured Italian cigars (Toscanelli's) for me...... and now Bike & Bee related Benadryls!

Timely & topical, keep your face shields closed and mesh jackets zipped!

Thank you guys.

[rph802]

Ok I read this very quickly but my understanding is that a person
can, have been stung several times in their life and even tho
they always just had localized reactions the anaphylaxis shock
could still hit them the next time they are stung.
JUst because you have been stung many times does not mean you
will not have probs the next time.

I hope that made since

I think there is some truth in there. Different people will react differently. Some people are just more sensitive to these types of reactions. Most every one will at least have a local reaction around the sting site (eosinophilic reaction right xaque?? Immunology was quite a while ago for me) but its a very non specific reaction. Certain groups like asthmatics are considered atopic, more prone the stronger, IgE type reactions. This is why you see the antihistamines like Zyrtec and inhaled steroids (Advair, Flovent,etc) becoming the mainstays of asthma treatment especially in kids.

Xaque, Dr Strangelove, another item that always used to be included in the anaphylactic kits for the crash carts at the hospitals I used to work at was an IV H1 antagonist (Pepcid,Zantac depending on the current formulary). Is that still being done?? Always seemed like one of this well it cant hurt and it might help sorta things. But that was about 10 yrs ago so just wondering if that had changed.

[Xray28]

As a lifetime "bug-o-phile" collector, and amateur entomologist...Here's my 2 cents worth.

Honey bees sting to protect their hive. They usually loose their stinger when they sting (It's barbed) and the rear end of their abdomen. This is a fatal wound to them. They leave the stinger, poison sack and contracting muscles that will continue to pump venom into you for some time if left undisturbed. Get the stinger out ASAP to reduce your dose of venom. Their venom is tailor made to hurt mammals like us. It might be possible to get sensitized to honey bees by eating honey. I think someone was doing research on this some years ago...Never found out the results.


Yellow jackets (Vespid wasps) sting for several reasons. One thing to remember is that they eat and get contaminated by decaying fruit and carrion. I had an arm swell up like Popeye's from a sting. I was told that they often not only cause an allergic reaction, but can inject infection producing organisms as well. I required a dose of antibiotics to get it under control.

[Dr. Strangelove]

that is correct.
previous benign exposure does not 100% predict benign reaction to the next exposure.

previous severe reaction should suggest future severe reaction.

Re: the pepcids/zantacs, etc ---no replacement for epi; I have not seen that on any "anaphylaxis cart" but have spoken to colleagues that have used it IN ADDITION TO Epi, not a replacement

John

[wncbmw]

All this is very interesting and perhaps I need to add at least Benadryl to the first aid kit I intend to put in the tank bag one day.

But most of us are more likely to die crashing the bike after being stung and not paying attention to our riding! I once had a wasp or something go down my shirt while on the Blue Ridge Parkway, past my unzipped jacket (it was hot!). It stung me several times as it worked it's way down to my navel! It was a great test of concentration to manuver to the shoulder and wait to pull up my jacket and shirt until I had stopped. Painful too!