Bee sting-- from the PATIENT"S perspective!

  1. I was out picking grapes yesterday and was stung by a bee, hornet, wasp, or yellow jacket- I don't know which because they were all buzzing around trying to get the sweet nectar from the ripe fruit. Anyway, my arm started swelling right away, but I didn't notice anything else for a while, then after 20 minutes or so I had this INTENSE itching of my hands and feet so I used my Epi-pen and had my husband drive me into the nearest E.D., about 15 minutes away from our house. By the time I got there, my breathing was tight, my HR and BP were elevated (120 and 170/90), and my SaO2 was 90%. (I had the Epi-pen because I'm allergic to NSAIDS and have had an anaphylatic reaction to them in the past-- first sx was the intense itching of palms and soles of my feet).
    They put me in a room and gave me Epi, Solu-Medrol, Benadryl 50mg IV (I don't do drugs well, I slept the next 3 hours there!), all which I expected because of my past anaphylacsis. However, they also gave me an Albuterol neb and Cimetadine IV, which I didn't expect.
    I was sent home after 4 hours with prednisone, tagamet, and claritin doses to be taken for the next 5 days. Because of the steroids, I've been up and jittery all night (I expected that! LOL), but was wondering about the other 2 drugs; is this standard for allergic reactions these days? The other thing that they told me was not to have my husband drive me in if it happens again; to call 911 and have an ambulance sent.
    Now, I don't know about the rest of you, but I HATE to be a patient and the whole ambulance thing is really something that I don't want to do! even though my husbands' driving can be erratic at times (I didn't tell the staff there that) and I hate to have him drive me anywhere, I would prefer not to cause a scene by having the ambulance show up here.
    So I have 2 questions for you:
    1.) is it necessary to call an ambulance for any future bee stings; and
    2.) will I be allergic to ALL of those stinging insects in the future; or just the one that stung me? Since I'm not sure which type of flying bee/wasp/hornet/yellowjacket got me, should I just wait for the itching to start again, or call for help as soon as I'm stung?
    Thanks for your help with this.


    Jenny
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  2. 10 Comments

  3. by   Marianne518
    Hi Jenny,

    I'm sorry to hear about your reaction to the bee sting (or whatever it was). I am extremely allergic to bees and I have learned my lesson about driving myself to the hospital. Last year I was stung by a bee on the day before labor day, used my Epi-Pen, and had my hubby drive me to the hospital. They did the exact same routine that you mentioned in your post....not sure exactly why, but that has always been the list of meds that I have received each time. Well, after spending about 6 hours in the ER that day they finally released me to home with all the usual warning signs and symptoms for me to return. I came home and slept like a rock, got up the next morning...labor day, and went outside to get the newspaper. When I got back in the house I sat down at my desk and felt something on my foot.....looked down and saw another bee....which proceeded to sting me on my toe before I had a chance to swat it away. I totally panicked because I didn't have another Epi-Pen close at hand and no one was here to help me. I did exactly what the doctors told me not to do...I got in my car and started to drive myself to the ER (which is only 3-5 minutes away). Well, that didn't work out too well because my airway started to close up on the way to the hospital and I ended barely making it into the ER. I left my car running in front of the ambulance entrance as I went into the ER and collapsed on the waiting room floor. I don't remember much after that because I ended up in the ICU for three days having had to be intubated.

    Please learn from my mistake and do not allow your husband drive you.....or ever attempt to drive yourself. They tell me that the reaction to these stings can become worse each time you get stung, so I think your best bet would be to call 911 to get you to the hospital. I now keep Epi-Pens in every room of my house (Yes, I am paranoid!!) and every one in my family has an Epi-Pen at their house for when I am visiting them, just in case of emergency.

    Marianne
  4. by   Talino
    Originally posted by Jenny P
    (1) is it necessary to call an ambulance for any future bee stings;
    In your case, with your first reaction to a "bee" sting, keep the Epi and Benadryl handy. When in unfamiliar places, always know where the nearest hospital is or if 911 is available.

    Originally posted by Jenny P
    (2.) will I be allergic to ALL of those stinging insects in the future; or just the one that stung me? Since I'm not sure which type of flying bee/wasp/hornet/yellowjacket got me, should I just wait for the itching to start again, or call for help as soon as I'm stung?
    Hymenoptera species are bees, yellow jackets, hornets, wasps, and some ants. If you're allergic to one, most likely you're allergic to all. But individual reaction varies.

    When I first got stung on the ear by a Yellow Jacket years back I developed a reaction (hives, mostly localized - thighs & lateral abs) 2-3 weeks after the incident. I am sure it wasn't from anything else more recent.

    Second time around, stung on my finger by same pesk, the reaction was immediate. Within 1 minute I broke out in hives, w/ generalized erythema but no respiratory difficulties. I wound up in ER (my wife panicked) and got Prednisone shots, Benadryl 50, but no Epi required. No other reaction...just all cutaneous. 'took home a week's dose of steroids.

    Recently, 'got another sting from the same pesk (don't they hate me) on my neck. Got Benadryl injectable ready and even Epi on hand. Since I really hate needles, I opted for 50 mg Benadryl po first and had the injectables on standby. This time all I got was a weal on the site of the sting but no hives. No delayed reaction so far.

    Am I safe? Did I develop some sort of hyposensitivity from frequent exposures? I consulted an MD. Hyposensitization seemed to be likely but won't rule out a delayed reaction and adamantly insist to keep Epi/Benadryl handy.
  5. by   RNPD
    Reactions do get worse with subsequent exposure. Anyone that has had such a reaction needs to see an allergy doc for testing and consider immunotherapy shots. The epipen is a lifesaver, but it's much better to stop the reaction before it starts by having shots. These protect you from a systemic reaction and keep it localized.

    The claritin is an antihistamine and cimetidine is a histamine blocker-both are used for anaphylaxis, since it is caused by a massive release of histamine in the body. The albuterol neb opens constricted airways. I am surprised that you were hypertensive Jenny-usually it causes hypotension leading to shock and eventually death. Thank God that you all were treated promptly.

    As far as the ambulance-I might let someone else drive me if it was a first time reaction-but if you have anaphylaxed before, you most likely will again-and most medics can initiate tx as needed.

    Good luck-and stay away from flower beds and open garbage where they like to gather. Also never swat-that is threatening and you will get stung. Try to stay calm and either walk away or try to gently brush it away.

    Hope this helps.
  6. by   Jenny P
    Thanks for the advice Marianne and Talino. I didn't mention that I couldn't get to sleep til 1AM last night, then have been up since 3:30AM, so I guess I'm overwired from the steroids. Fun times, huh? I just hate it when it's time for the next dose and I become WITCHY!!!!!
    I never would have tried to drive myself in alone, Marianne, if I was alone, I'd probably call a friend to take me in. That must have been really scarey for you. And I don't blame you for being paranoid, I usually keep 2 Epi-pen in my purse at all times, but one was outdated. My reason for the Epi-pens was the allergy to NSAIDS; I don't give them at work (if they are oral, I ask another nurse to give them) except Toradol, which I feel safer giving since I don't squirt it all over when expelling the excess air-- I double glove for that and carefully expell the excess med into a disposable glove which I then toss.
  7. by   Jenny P
    Thanks for the advice RNPD and Wildtime. I guess that I will call 911 next time. RNPD, my normal BP is usually around 90/50, so maybe it's a good thing that it was high by the time I got to the ED; I would have really made them nervous if it was my normal pressure! Doing CV-ICU all these years I've lost track of a lot of the emergency medical treatments and I hadn't ever read about the Tagamet or Claritin for bee stings before. My girl friend came over and "helped" me can 22 quarts of grape juice today-- she did most of the work and kind of pushed me along. I think her real reason for being here all day was that as a nurse midwife she was worried about me and wanted to make sure I was okay; that plus my hubby bribed her with a gourmet supper for all of her work. She just made me take some Benadryl and sent me to bed, but I had to check on this thread before the drugs hit. Good night, all!!!!
  8. by   SharonH, RN
    Originally posted by Talino



    When I first got stung on the ear by a Yellow Jacket years back I developed a reaction (hives, mostly localized - thighs & lateral abs) 2-3 weeks after the incident. I am sure it wasn't from anything else more recent.

    Your post got me to thinking. At six years old, I was stung by a bee/wasp/yellow jacket with no reaction. Last year, I was stung multiple times by one of them. At the time of the attack, I took 50 mg of Benadryl PO and went on with my business. Two weeks later, I woke up with the hives. I went to the ER and got the Benadryl/Epi/Solumedrol injections. I am positive that it was because of the bee stings. But now I am wondering if I will have a more severe reaction if I am bitten again. Perhaps I should keep an Epi-pen on hand myself?
  9. by   P_RN
    One addition to all the excellent ideas above. My husband's allergist always has him carry LIQUID Benadryl. He says it goes to work faster. Makes sense to me.

    I never was stung until about a year ago.....that's over 50 years!

    Swelling etc immediately....scared to death because it's an hour to ANY hospital....and it takes EMS about 30 minutes to get here..... Guess I have to rely on someone to drive me ( I don't drive either) and take my chances?


    Anybody know anything about fire-ants? I have discovered if you immediately rub the bites with an antiperspirant (the chalky sports kind-not roll on or spray) that the bites don't blister and don't hurt. Just a little free advice.

    P
    Last edit by P_RN on Sep 3, '01
  10. by   Talino
    To SharonMH31...

    Ohio State University Extension Fact Sheet
    Entomology
    1991 Kenny Road, Columbus, OH 43210-1000

    Bee and Wasp Stings
    HYG-2076-96
    William F. Lyon

    Systemic Sensitivity
    Doctors believe that once systemic sensitivity occurs, it almost always increases in severity with each following sting (varies in individual persons). The more quickly symptoms appear after the sting, the more severe the reaction. (Some beekeepers can no longer keep honey bees after several years due to severe allergic reactions developing). The problem occurs when some individuals produce excessive quantities of antibodies in their immune system. The excess antibody production usually follows the initial sting to which there is no reaction. However, when the person is stung again, the insect venom entering the body combines with the antibody, produced by the first sting, which triggers a series of internal reactions, resulting in severe allergic symptoms.
    More helpful info about stings....
    http://www.ag.ohio-state.edu/~ohiol.../2000/2076.html

    ______________________________
  11. by   CEN35
    wanted to help you out? Not a lot else left to say? everybody covered it all!



    me
  12. by   Jenny P
    JUST WANTED TO SAY "THANK YOU" FOR ALL OF THE ADVICE. It's nice to be able to ask questions and get straight answers here from other nurses who are in areas of nursing that you are not familiar with anymore. THANK YOU EVERYONE!

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Bee sting-- from the PATIENT"S perspective!