Eunice Wonnacott asked:

> I will experience severe chest pain, difficulty
> breathing, pains in shoulders and upper arms, swelling tongue,  eyes
> pouring
> tears etc etc.  I presume this is "real" ?
>    Is an epipen not effective for this?

An Epipen contains adrenaline - a heart stimulant - and is used to treat
severe systemic reactions and anaphylaxis, i.e. life threatening reactions.
But it is not a complete treatment - only an emergency treatment intended to
keep the patient alive until they can reach a hospital.  In my unqualified
view, your symptoms would seem to fit this description and I think that you
should discuss this further with your GP, with a view to seeing a
specialist.

There have been many opinions and numbers bandied around on the list
recently, but anyone wanting a good overview written in terms that most
laymen will understand might do well to read Harry Riches book 'Medical
Aspects of Beekeeping'.  For those who do not know the name, Harry Riches
worked at Harefield Hospital (of heart transplant fame) and is a world
authority on bee venom allergy.  He is also a beekeeper and has suffered
from bee sting allergy - which progressed from gross local swelling to
collapse after a single sting.

In the book, Harry makes the point that it is very difficult to give numbers
for people allergic to insect stings, but quotes a survey in the UK that 10%
of the population are stung each year by bees or wasps (most would probably
not know the difference!) and some 40,00 suffer reactions serious enough to
merit further investigation.  He also states that in the US, it is widely
accepted that between 1% and 2% of the population may be 'at risk'.

It is clearly important that beekeepers have at least a basic knowledge of
the types of reaction that may occur, the reason for those reactions, the
likely effect of further stings - and any appropriate treatment.

Briefly:
1. The first sting will normally produce pain, local swelling, redness and
itching which may take several days to abate.  Of course, many of the public
consider this to be an allergic reaction.
2. What happens next will depend on the person being stung.  There are two
immunoglobins involved - IgG and IgE.  If the body produces IgG, then
further stings will have a diminishing effect until immunity is achieved.
If the body produces IgE then increasingly severe reactions are likely:
3. Next, gross swelling - perhaps an entire limb.  Stings to the mouth or
neck can be very dangerous here, as airways can be blocked.
4. Then mild systemic reactions - wheezing, watering eyes, urticaria (nettle
rash, usually over large parts of the torso).
5. Then severe systemic reactions - difficulty breathing, unconsciousness
and, in the most severe cases, anaphylaxis which if not treated rapidly may
lead to death.

Of course, this is a simplified version.  It is possible to go from local
swelling to collapse.  Equally, beekeepers who have suffered moderate
symptoms (4. above) may ultimately develop immunity (I did so myself and so
did my wife).

Peter Edwards
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