They're back -- honeybees, yellow jackets, hornets and wasps. For most of us, insect bites are a minor nuisance, but for a small percentage, those who suffer from what is usually called "an allergic reaction" to insect venom, insects can be a source of worry and anxiety.
The good news is that fewer than 50 deaths from insect stings are recorded in the United States each year. The worrisome news is that the number of people likely to have a severe reaction to insect stings is estimated to be in the tens of millions. Children are particularly vulnerable as they play outside and eat sweet foods, which attract these insects.
I asked Dr. Lawrence Lichtenstein at the Johns Hopkins Asthma and Allergy Center for his advice about this summer problem.
Q: What happens when you're stung?
A: For most women and children, an insect sting results in several hours of mildly uncomfortable swelling, redness and itching in the area around the sting. For some, there may be a larger area of swelling around the bite with redness and pain for several days.
However, in a few cases, a systemic or allergic reaction leads to swelling and blocking of the airways, shock and hypotension (abnormally low blood pressure). This kind of allergic reaction requires immediate medical treatment.
Interestingly, a study undertaken at Hopkins showed that women are more likely to have severe local reactions, while men are more likely to have a systemic reaction.
Q: What should I do if I am stung?
A: If you or your child have been stung before and have not had a severe reaction, the chances are that you are not allergic to insect venom and medical treatment is not necessary. However, wasp, yellow jacket and bee stings are each different and it is possible to be allergic to one and not another.
The discomfort caused by the sting can usually be eased with an over-the-counter cream or even an old-fashioned remedy like baking soda mixed with a little water. However, if you or a child have reacted severely to a previous sting, you should seek immediate medical treatment. In some adults who have had severe reactions, immunotherapy with insect venom -- that is, a series of injections to build an immunity to the venom -- may be recommended.
Q: What about my children?
A: Children are stung more often and they react somewhat differently to stings than adults. Children's reactions, even those that are more severe, tend to be limited to the skin, with only 25 percent of children having any respiratory distress or hypotension. Most of these severe reactions can be effectively treated with epinephrine, which is available in emergency rooms and doctors' offices, and children with severe reactions should be treated with immunotherapy. For those children (and adults) who have severe reactions to insect bites, carrying an emergency kit with epinephrine for immediate use may be recommended until immunotherapy has been completed.
Q: What can I do to prevent insect stings?
A: Without spoiling your child's enjoyment of the summer, be careful about drinking and eating sweet things outside. Be particularly careful around trash cans and anywhere where there is a concentration of sweet foods.
Never antagonize a bee or a wasp. If your children spend a lot of time outside, make sure they know how to recognize the nests of wasps, hornets and bees, and the ground holes of yellow jackets and know to avoid them.
And, it is best not to let your children run around outside without shoes -- many bites come from honeybees and yellow jackets stepped on by bare feet.
For more information about insect bites and allergic reactions, call the Johns Hopkins Asthma and Allergy Center at (410) 550-2309 or (410) 550-2310.
Dr. Matanoski is a physician and professor of epidemiology at the Johns Hopkins School of Hygiene and Public Health.