Bee Sting

Allergy to bee stings refers to allergic reactions such as hives, asthma and anaphylaxis caused by bee stings, which are caused by common bees, large bees or date bees, honey bees and paper bees.
In subsequent stings, in addition to local reactions, it can become systemic and progress to the stage of anaphylactic shock. It is one of the most effective success of vaccine therapy in bee sting allergy.
Some special ants found in Larestan and Bandar Lange can cause severe allergies and anaphylaxis.

Insect bites often cause skin reactions such as popular urticaria, eczema, giant urticaria, general urticaria, and in some cases, acute reactions (anaphylaxis), especially in children.
Even though anaphylaxis has even been reported due to mosquito or ant bites, however, bee sting venom plays a major role in causing severe acute and sometimes fatal reactions, which is why sufficient attention is paid to the mechanism and knowledge of treatment methods. And its prevention is very important for doctors.
Venom of bees from the Hymenoptra category, which includes honey bees and yellow and red bees (YellowJacket-Hornet-Vasp). It is more allergenic than other types of bees.
The poison of a type of red ant (Fire Ant) is also effective in causing anaphylactic sensitivities in America. According to statistics, 0.4 to 3% of people in different parts of the world experience severe aphylactic reactions due to bee stings, and unfortunately, every year a number of these people die due to bee stings. Shock and collapse die.

As a result of a bee sting, two types of reactions occur in sensitive people:

1. Acute and early reactions that may occur from a few moments after the bite to 4 hours, which include:
   local reactions that may not be allergic and related to the pharmacological effect of the poison.
   Severe local reaction, severe urticaria and edema.
   General reaction such as asthma, general urticaria, drop in blood pressure, nausea and vomiting, anesthesia and sometimes sudden death.
   These two types of reactions are often caused by the mediation of Igee and due to the rapid release of chemical mediators in the blood.
   Finally, toxic reactions that occur as a result of multiple bites at the same time and the entry of a large amount of poison into the body do not have an immunological aspect.
2. Late reactions that are less common, such as:
   serum sickness, Guillain barre syndrome, glomerulonephritis and myocarditis.
   Sometimes, after being stung by a bee, the patient suffers flu-like symptoms such as fever, severe chills, muscle and bone pains that last for several hours.
   In some people and children, there is a history of previous bites and similar reactions, but sometimes even severe anaphylactic reactions may be caused by the first insect bite.

• Vasoactive peptidoamines, which are not allergenic, but have pharmacological and inflammatory effects.
• Enzymes such as hyaluronidase, phospholipidase, acid phosphatase, which are often different in all types of bees in terms of allergenicity and sometimes have conflicting allergenicity, these enzymes are the most important allergens in bee venom.
• Mellitin in bee venom and Antigen5 in yellow bee are more specific aspects.
  It is important to pay attention to the following causes and be familiar with bee sting sensitivity.
• These reactions occur suddenly and without prior warning in a completely healthy child, and in the blink of an eye, they cause anaphylaxis and shock and quick death within a few minutes.
• It often happens in special time and place conditions, such as outside the city, during a picnic and playing in the farm and garden, that access to medical facilities may not exist.
• With timely diagnosis and quick treatment, these reactions can be reversed and save the child’s life. In addition, there are enough facilities to prevent the recurrence of these reactions and remove the sensitivity.

Children and people who have a history of acute reactions due to bee stings should carry the basic medicines necessary for emergency treatment in a small bag (Kit) and they and those around them should be familiar with the method of using these medicines, which should contain epi ampoules. Epinephrine 1/1000 is an antihistamine ampoule such as Diphenhydramine or Clemastine and Hydrocortisone ampoule along with several syringes and a tourniquet and some antihistamine tablets.
Immediately after the bee sting, a tourniquet is placed on the upper part of the injection site to slow down the amount and entry of the poison into the general blood stream, then an epinephrine ampoule in the amount of approximately 0.2 to 0.3 cc is injected under the skin and then an antihistamine ampoule is injected into the muscle. or injected intravenously.
Epinephrine ready for injection is supplied in the form of a pen that is injected into the skin by pressing its tip called Epipen, which is very effective and easy to use.
Usually, by injecting an epinephrine ampoule alone, the initial risk of shock will be eliminated and there will be enough time to direct Limar to medical centers for drowning observation.
In case of symptoms of drop in blood pressure and shock, hydrocortisone ampoule will be used, and then Vasyl serum and other drugs will be used in medical centers to treat shock.
Considering that sometimes after the primary acute reaction is resolved, a secondary reaction may occur after a few hours, it is better to prescribe anti-allergic drugs and monitor the patient even after the patient has fully recovered.
Follow-up
One of the most successful and effective cases of using immunotherapy in allergy is the removal of sensitivity to bee venom, which has been effective between 90 and 95%.
After performing skin tests or RAST test, which is done with the pure venom of zenivers, immunotherapy with regular and gradual infusion and increasing dose of bee venom allergen is started and after reaching the maintenance dose, which is usually between 50 and 100 micrograms of venom. This dose is repeated every 4 to 6 weeks. In most patients, it is enough to continue the treatment for 3-5 years.

Allergy files of 14 Iranian children from different parts of Iran (one patient each from different provinces, 4 patients from Tehran and 2 patients from Yazd) were reviewed, the age of the patients was between 4 and 16 years (average 10 years), of which 12 were boys (86%) and 2 were girls (14 These children had a history of 1 to 6 bee stings with allergic manifestations (2 times on average).
Clinically, many of them developed general urticaria and shock, and sometimes they had shortness of breath and asthma, general urticaria in 12 cases (86%), shock in 10 cases (71%) and asthma in 3 cases (21%).
In the intradermal tests that were performed using three types of Venom, Honcy-Mixed Vespid
Vasp-Bee with concentrations of 1.1000 micrograms, 1.100 micrograms, 1.10 micrograms per cc, the positive cases were as follows.
(78%) Case=Mixed Vespid-(18%) Case 4=Wasp-(70%) Case 10=Honey Bee

It should be kept in mind that due to the presence of antigenic crossover between bee venoms, in some cases the patient may have a skin reaction to two or even three different types of bees, but the selection of a specific allergen for immunotherapy is based on the patient’s history and the type of allergen. which has reacted with a lower concentration.
It should be considered that the use of bee venom with a higher concentration such as 1 microgram per cc for testing reduces its clinical value because in high concentrations non-allergic local irritant effects may occur.

Summary:
Allergy to bee and ant sting venom due to acute anaphylactic and sometimes fatal reactions should be considered by doctors and especially pediatric specialists because with timely recognition and prompt action, this reaction can be reversed and treated, in addition to preventing the occurrence of In the following events, the possibility of removing the sensitivity is almost completely available.
Children who have a history of acute reactions due to bee stings should be introduced to special allergy centers for immunotherapy and allergy relief as soon as possible, while preparing and carrying a special kit of emergency medicines and familiarizing themselves with them.
Immunotherapy with bee venom extract is successful in 90-95% of cases.
In the study of a number of Iranian children who had a history of reaction to bee stings, it was found that a number of boys were significantly (86%) more than girls and the reaction to yellow bees and honey bees was more common.