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Emergency! An Allergic Reaction To Insect Stings.

In and out of school, children are prone to all sorts of disasters. Unfortunately, often such emergencies occur with shocking swiftness. Often, too, they come as a surprise, "out of the blue" so to speak.

A systemic allergic reaction to an insect sting is just such an unforeseen contingency. It frequently occurs without prior warning. Neither parents nor the school authorities are aware that the child has developed sensitivity to insect venom. And it can occur as a medical emergency, a life-threatening situation.

We are accustomed to childhood encounters with Hymenoptera (bees, wasps, yellow jackets, homets, stinging ants) as a natural consequence of children's curiosity and energetic exploration of their worlds. We are not accustomed to the notion that on occasion such encounters can be severe, even fatal. Most people, however, are probably aware that multiple stings can be toxic and the consequences severe. Very few find it creditable that three, two, or even a single sting can cause death within half an hour, often within the first ten or fifteen minutes of the sting. Yet, for the severely allergic, such an outcome is highly possible. There are cases on record of fatal outcomes to one or two stings within two or three minutes of the victim's being stung. Anaphylactic shock strikes hard and swiftly.

Such hypersensitive individuals, of course, are relatively few, but there are far more of them than is commonly supposed. It has been estimated that 0.4 to 0.8 percent of the general population has reacted to insect stings with systemic symptoms. Annually, more people die as a result of insect venom than they do from snake venom, and while some of these victims succumb to the toxic effects of multiple stings, many fatalities are the results of allergic reaction to one or two stings.

When we consider that one in four or five children is allergic to something they inhale or ingest, contact or is injected into them, we can realize the potential for systemic reactions to insect stings among the school-age group. More often than not, allergies are multiple. It should also be noted that there is apparently a reasonably high correlation between allergy to drugs, penicillin especially, and allergy to insect stings and bites.

To be realistic about it, while tens of thousands of children are stung each year by one or more members of Hymenoptera, only a few will exhibit symptoms of a generalized reaction. Of these, only a handful will die, but these fatalities are all the more tragic because they are needless. Proper steps swiftly taken could have saved their lives. First, the symptoms of allergic reaction must be rerecognized and secondly, must be treated immediately with an injection of epinephrine, the only drug that can stave off fulminating systemic symptoms long enough to get the victim to a physician or hospital emergency room.

Most reactions to an insect sting are mild and very normal. There is transient pain, a small reddish area at the sting site that becomes surrounded by a whitish zone and red flare. This reaction, called a "wheal," soon subsides. It may feel little a little warm and itch, but it quickly vanishes and the encounter may soon be forgotten.

Treatment consists of scraping out the stinger, if one is present, with fingernail or knife (squeezing only pumps more venom into the wound) and washing the area well with soap and water. A mild antiseptic can be applied and an ice pack to soothe. Some members of Hymenoptera are scavengers, notably yellow jackets and wasps. Parents should watch for signs of secondary infection and consult a physician immediately if such symptoms develop.

Some youngsters respond to an insect sting with an unusual amount of edema (swelling) at and beyond the sting site. Such swelling may appear immediately or sometime later. Frequently an entire limb is involved. Again, while such edema may simply be a local reaction to insect venom, then is the possibility that it signifies cellulitis (infection of the skin), especially if the area becomes very warm and red.

A generalized systemic reaction, also called an anaphylactic reaction, to an insect sting often begins with a dry, hacking cough and a sense of constriction in the throat and chest. The eyes may begin to itch and the area around the eyes swell. Hives, sneezing, wheezing, and either paleness or flushing may accompany these initial symptoms. The child may become uneasy and complain that he "feels funny." His pulse may become rapid, while his blood pressure will fall. If the reaction is severe, symptoms may progress rapidly to any combination of the following: nausea and vomiting, dizziness, faintness, cyanosis (a bluish color of the lips, ears, and finger tips), laryngeal stridor (funny breathing sounds due to closing off of the breathing tube, the trachea), chills and fever, collapse, incontinence, unconsciousness, and bloody, frothy sputum.

Without emergency first aid treatment on the spot, death can occur within the first ten minutes. There may not be enough time to get the victim to a physician or hospital. For this reason, I have long advocated that school nurses (and others responsible for public safety) have an insect sting kit as a regular item in their first aid kit. The insect sting kit is not designed to replace emergency care by a physician. It's designed to buy time until the victim can receive proper care.

There are several types of such kits on the market. They contain a vital epinephrine for injection under the skin; 0.3 to 0.5 cc. for adults, 0.2 to 0.3 for children. Many kits have a self-injecting syringe. There are also sterile alcohol pads, a tourniquet, and, in one type of kit, antihistamine tablets. Instructions accompanying the kit are explicit. In addition to injecting the epinephrine and applying the tourniquet, application of ice packs will help slow absorption of the venom. But I emphasize -- utilize the kit and rush the child to the nearest physician or hospital.

Parents should understand the potential seriousness of even a mild reaction to an insect sting. They should be advised to consult a physician or allergist at once, for several steps can be taken to avoid future tragedy. The child can be desensitized to insect venom and kept on a maintenance dose that will protect him against normal future encounters with Hymenoptera.

Your physician will prescribe an insect kit (I prescribe three for my patients--one to be kept in the house, one in the glove compartment of the car, and one to be carried on the person whenever and wherever Hymenoptera and the patient could collide). I instruct the parents and children in the use of the kits. The child should wear a medical warning tag or bracelet to ensure swift diagnosis in the event of another allergic reaction.

The insect sting kit, while designed for a specific purpose of combatting systemic symptoms to insect venom, is also applicable to anaphylactic shock due to other causes, such as systemic reaction to drugs or potent food allergens.

Dr. Frazer is an allergist practicing in Asheville, NC. He is a regular contributor to Pediatrics for Parents.
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Title Annotation:in children
Author:Frazier, Claude A.
Publication:Pediatrics for Parents
Article Type:Brief Article
Geographic Code:1USA
Date:Jun 1, 1998
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