Stings and Allergies
Dear Dr. Lanny:
I am highly allergic to bee stings. I don’t know if my children are, too. And I’m worried about how to prepare if they get stung at some point. What do I need to do to be ready?
A: When talking about allergy in general, I have read that if one of your parents has allergies, you have a 30 percent to 50 percent chance of having allergies as well, although not necessarily to the same allergens. If both your parents have allergies, almost certainly, so do you.
In the case of a specific allergy, bee stings in your case, there may be some increase compared to a family without any allergic history, but not to any significant degree. Although the relationship between specific parental and child allergy is slight, I could certainly understand a parent’s anxiety and desire to have a child tested.
Whether your child really requires testing is a much more difficult question. If the child has never been stung, or has been stung and had only a local reaction, then probably testing is unnecessary. Unhesitatingly, there are physicians who would disagree with that position and strongly recommend testing. In researching this column, I spoke to two insurance companies and to the billing department of a local allergy and immunology practice. The experience of these different resources suggests that most insurance companies will approve testing based on family history. There are exceptions, so discussion with your customer service representative is wise before possibly bearing a substantial bill.
When stinging insect allergy testing is elected, venom testing is the test of choice. This entails injecting very small amounts of venom from bees, wasps, yellow jackets and hornets into the skin and monitoring for reactions. All the stinging (not biting) insects are tested for, as patients, particularlyyoung children, may not know what stung them, and all are capable of causing severe allergic reactions.
Whether or not your child undergoes testing, there are a relatively few preventive or treatment steps you need to consider. As always, preventing close encounters of the worst kind is your primary goal. Removal of nests anywhere that your child is likely to play is first and foremost. If you have had significant reactions yourself—for example, throat tightness, difficulty breathing, feeling of faintness or total collapse—hire a professional to clear your home or yard of stinging insects. Keep garbage covered, and try not to provoke the insects. They have no more desire to mess with you than you do with them. Stinging insects are unlikely to sting unless you are swatting at them or disturbing their hive.
Have Benadryl (diphenhydramine) available in liquid, chewable or capsule form. Check with your doctor about the proper dose, and be sure your medication is not past its expiration date. If the circumstance ever occurs that you need to use the medicine and you realize it is outdated, use it anyway and immediately get a new supply. Outdated medicines are extremely unlikely to “go bad,” but they may have lost their effectiveness. EpiPens are used to inject epinephrine into the thigh and can be life-saving. They are simple to use although usually not necessary, and it is definitely creepy to stick a needle into your own or your child’s leg. Have a discussion with your doctor as to whether you really need to have an EpiPen available.
Although approximately 40 to 50 people die each year from insect stings, in a country of more than 300 million people that is one death per 7.5 million. Not exactly a high risk.
I’d like to take a moment to write a few words about dreaded spider bites. Over the years it is hard to imagine the number of times parents have come to the office concerned that their child has been bitten by a spider. And yet, in all—and I mean all those times—no parent has ever seen the offending spider. And the reason is simple: Spiders don’t bite your children. Yes, there are black widows, and yes, there are brown recluses, but in more than 30 years of practice I’ve yet to see a child bitten by either. Better you worry that your child doesn’t run out into the street, or ride a bike without a helmet, than worry about spider bites. Most spiders would far rather eat a mosquito than bite you, and any creature that eats mosquitoes is our friend. ■
Dr. Alan Freshman, father of two grown sons, practices at Syracuse Pediatrics. Consult your own physician before making decisions about your family’s health care. Send e-mail to him at firstname.lastname@example.org.