Once an allergy to hymenoptera has been confirmed, the first thing to do is to protect the patient from a possible new bite. This is called primary prevention and is the basis of treatment. Activities that increase the risk of possible exposure to bees or wasps should therefore be avoided. Therefore, drinking and eating (e.g. picnics) outdoors, walking barefoot, gardening (especially cutting flowers and pruning hedges with bushes) and fruit picking should be avoided. Outdoor activities (especially wearing colorful, fancy clothes) increase the risk especially if accompanied by open-mouthed activities (e.g. running) as does being in the vicinity of beehives (especially during the honey harvest season). The use of strong perfumes should also be avoided, especially in the evening hours when insects are most aggressive. Finally, checking for the presence and removal of nests, usually located on roofs, attics and other natural or artificial recesses, is particularly important.
Hymenoptera bite only when they are on the defensive and therefore disturbance should be avoided. In the event of a bee sting, the stinger remains at the site of the sting and should be removed immediately as the longer it remains in the skin, the more venom enters the body and the greater the reaction may be. Removal should be done from the bottom up, since very often the venom sac remains with the stinger, so careless removal can cause more venom to enter.
In a previous chapter it was mentioned that in case of anaphylaxis the probability of a corresponding dangerous reaction to a possible new nystagmus is more than 50%. Therefore, after identifying the insect responsible and discussing the precautionary measures, medication is administered according to the severity of the reaction.
This is divided into two categories. The first is symptomatic treatment, i.e. medication that should be administered immediately in the event of a bite and which should always be kept close to the patient wherever he or she moves (child at school, at work, in the countryside or on the beach, etc.). Hymenoptera are everywhere and medicines should not be left in the medicine cabinet at home! It is essential that the patient has a first aid kit with them at all times, including an automatic adrenaline injection (pen), antihistamine and cortisone preparations and possibly inhaled medicines. The administration instructions are clear, follow the recommendations of international organizations such as the European and American Academies of Allergy and Clinical Immunology, and their application is life- saving. All instructions are given in writing and described in detail to the patient and their loved ones.
The second, and most effective, class of treatment is immunotherapy. Immunotherapy is a causal intervention. It involves the immune system 'learning' the poisons, developing defence mechanisms against them and thus ensuring that a potential new bite will not cause a dangerous reaction. It is mainly indicated in case of anaphylaxis and in some specific cases of milder reactions (e.g. in beekeepers). Immunotherapy should not be used as a preventive measure or in cases of mild local reactions.
The success of immunotherapy depends primarily on the accurate recognition and identification of the allergen responsible and is 85-90% for bees and over 90% for wasps. Especially in children, whose immune system seems to be more flexible, the success rate is even higher. Successful immunotherapy means that the patient can tolerate a bee or wasp sting and suffer absolutely nothing or have only a local, mild reaction, however dangerous it may have been in the past.
Dr. Dimitris Mitsias
Allergy Unit NKUA