"Susan H. Gilbert" wrote:
> The best authority to refute your friend's theory would be an
> immunologist/infectious diseases specialist, someone with a sound
> understanding of what is and is not known about the differences in the
> functioning of the immune systems of people who are, versus people who
> are not, sensitive to various allergens, including agents in bee venom....
There are many myths surrounding bee stings and bee allergies.
Two of these relate to people being allergic to bees. This is a fallacy --
we don't say people are allergic to cows. People are allergic to milk or
milk products -- how many are allergic to beef or leather? Likewise, if
someone is allergic to bee sting venom, they are absolutely NOT allergic to
bee pollen, royal jelly, honey etc. There is zero evidence to suggest
otherwise. Bee product suppliers are doing themselves a disservice by
putting warning labels on products regarding people allergic to bees -- no
such allergy exists regarding bee products.
Secondly, it is believed that a lot of people die from bee stings. This also
is not true. In fact people have a greater chance of dying from being struck
by lightening that being killed by a bee sting. In the USA for example, less
than 20 people die each year from stings -- including bee stings. Compare
that with between 100,000 and 160,000 people dying every year from properly
researched, properly regulated, properly prescribed and properly used drugs
each year. Add to that the 45,000 - 90,000 people who die as a result of
preventable medical error in our hospitals each year and you have some idea
of the comparative risks involved with bees.
There is no evidence to show that people with asthma or other allergies are
any more susceptible to bee stings. Studies show that about 0.8% of both
have allergies to bee stings. People with asthma have a slightly more severe
reaction, but the frequency is no more.
There is no significant evidence to suggest that bee keepers are more or
less prone to allergic reactions to bee stings, although there is good
evidence that the longer one has been beekeeping the less allergic one is.
This could be because allergic people quickly quit the business or that
people are desensitized.
Another myth is that you should use a sharp instrument to remove bee stings
so that you don't pump bee venom into the skin in the process of removing
the sting. The following article is from the British medical journal called
The Lancet and demonstrates that speed of removal is the best means of
reducing exposure to venom from bee stings.
People who are known to suffer serious allergic reactions called anaphylaxis
should carry an epinephrine syringe with them at all times. Their
colleagues/friends/family should also know where it is and how to use it as
it is a proven life saver. People involved in Apitherapy, however, suggest
the most important factor in anaphylaxis with bee stings is not to panic.
In summary: the chances of dying from a bee stings are infinitely less than
dying from a visit to the doctor, and much less than dying from being struck
by lightening. I would suggest that dying from stress thinking about it more
likely too.
Regards
Ron Law
Lancet Volume 348, Number 9023 3 August 1996
Removing bee stings
P Kirk Visscher, Richard S Vetter, Scott Camazine
Department of Entomology, University of California, Riverside, CA 92521,
USA (P K Visscher PhD, R S Vetter MS); and Department of Entomology,
Pennsylvania State University, State College, Pennsylvania, USA (S Camazine
MD)
Correspondence to: Dr P Kirk Visscher
Summary
Background Conventional advice on immediate treatment of honey-bee stings
has emphasised that the sting should be scraped off, never pinched. The
morphology of the sting suggested little basis for this advice, which is
likely to slow down removal of the sting.
Methods The response to honey-bee stings was assayed with a measurement of
the size of the resulting weal. Injection of known quantities of venom
showed that this measurement is a good indicator of envenomisation.
Findings Weal size, and thus envenomisation, increased as the time from
stinging to removal of the sting increased, even within a few seconds. There
was no difference in response between stings scraped or pinched off after 2
s.
Interpretation These data suggest that advice to patients on the immediate
treatment of bee stings should emphasise quick removal, without concern for
the method of removal.
Lancet 1996; 348: 301-02
Introduction
Bee stings are common and painful, and rarely, deadly. 10% of people in a
1981 poll in the UK reported having been stung by bees and wasps in a year,
with 0·7% of these having severe symptoms.1 Bee stings cause about 17 deaths
per year in the USA.2
Most published advice on the immediate treatment of bee stings states that
the sting should be scraped off--perhaps with a knife blade, credit card, or
fingernail--and never plucked out by pinching with forceps or fingers.3-5
Our examination of the structure of the bee sting apparatus caused us to
doubt the soundness of this advice, especially since scraping off a sting
with a tool takes longer than simply brushing or pinching it off. We tested
the relative envenomisation resulting from these two means of removing
stings, and the effect of short delays in sting removal.
The sting detaches from the body of a honey bee (Apis mellifera) after
stinging humans,6 taking with it the entire distal segment of the bee's
abdomen, along with a nerve ganglion, various muscles, a venom sac, and the
end of the insect's digestive tract.7 The sting itself consists of two
lancets with curved barbs on the outer aspect of their distal end, held in
grooves on the stylet. Muscular movements of the detached sting, coordinated
by the attached nerve ganglion, move the stylets alternately. The barbs
provide one-way traction, so that the sting continues to work itself deeper
into the flesh. A valve and piston on the proximal ends of the moving
lancets pumps venom from the sac between the stylet and the lancets, and
through an opening near the tip into the wound.
Methods
To assay the venom injected by a bee sting, we measured the area of the weal
raised on our own forearms after bee stings. In preliminary observations,
the raised white weal achieved its maximum size about 10 min after the
sting. Measurements were blind: the observer was unaware of the treatment
administered. 10 min after each sting was administered, the observer
measured the maximum and minimum diameters of the raised portion of the
weal, using a digital caliper.
To ensure that weal size was a valid assay of envenomisation, we measured
the size of weals resulting from intracutaneous injections of 5 µL water
containing various doses of dried bee venom (1 µg, 3 µg, 10 µg, 30 µg, and
100 µg). Bee stings contain about 150 µg dry weight of venom, of which only
a small fraction is typically injected. The five solutions of venom were
injected twice each into one volunteer (PKV), by means of a microlitre
syringe and a 26 gauge needle.
All stings were self-administered. The area to be stung was sterilised with
ethanol. We collected a worker honey bee as she flew from her hive, grasped
her by the wings, and pressed her against the skin of the inside of the
volunteer's forearm until she stung.
We then compared the effect of small delays in removing stings with the
effects of different methods of removal. For the time series we marked five
(numbered) sites on each forearm of the volunteer and assigned five
treatment intervals to those sites in a randomised-block design. Each
treatment consisted of leaving the sting in the arm for 0·5 s, 1 s, 2 s, 4
s, or 8 s, and then scraping it out with the edge of a credit card. The
observer, unaware of which treatment interval corresponded to each site,
measured the weal from each bee sting 10 min after it was administered. We
collected data on five five-sting series on each arm of the volunteer (PKV).
We then assessed the envenomisation resulting from removal of bee stings by
scraping or by pinching. After receiving stings, the volunteer removed the
sting from his arm after 2 s by either scraping it off with the edge of a
credit card, or by pinching the sting between his thumb and forefinger and
pulling it out. This procedure was repeated on the other arm, with the
alternative treatment. Which arm received which treatment was assigned
randomly and was concealed from the observer. We collected data on ten
stings of each treatment from each of two volunteers (PKV and RSV).
We calculated the area of the weals, most of which were elliptical: Area=pi
x diameter 1 x diameter 2 ÷ 4.
We performed regressions of weal area on injected venom dose and on time to
removal, and ANOVA comparing responses at five (proximal to distal) sites
and between arms. We analysed the removal method series by ANOVA on the weal
area, with factors of removal method, volunteer, and right or left arm
nested within individual volunteers.
Results
Increased venom dose led to larger weal sizes (figure 1). Weal area was
approximately a log-linear function of dose (p=0·000016). Injection of water
alone raised no weal.
Figure 1: Dose-response curve of mean sting-weal area (±SE) 10 min after
cutaneous injection of venom
There was a significant increase of weal area with increasing time from
stinging to removal (figure 2, p=0·018). Neither location of the sting nor
arm had a significant effect (ANOVA p=0·58, p=0·60, respectively).
The weal area in response to stings removed by scraping (mean 80 [SE 5·9]
mm2), was greater than that of stings removed by pinching (74 [5·1] mm2),
but this difference was not significant (figure 2, ANOVA, p=0·42). There was
no significant difference between volunteers or arms within volunteers
(respectively p=0·45, p=0·71).
Figure 2: Mean (±SE) responses to stings as a function of time to removal
and method of removal
Location of the sting had no significant effect, but the tissue response
(weal area) at 2 s was lower (though not significantly so) in the time
series than in the removal method series (t test, p=0·12), possibly because
of the presence of multiple stings at the same time in the time series.
Figure 3: Bee sting in skin. Sting consists of barbed lance, venom sac and
muscles which continue to penetrate and pump venom into wound after
separation from bee
In a small number of instances, the scrape treatment resulted in breakage
of the sting lancets from the rest of the sting (the lancets remaining in
the volunteer's flesh); this breakage did not occur with pinching, and it
did not lead to an increase in weal area.
Discussion
Our sting weal bioassay accurately reflected the quantity of venom received.
The increase in weal area with increasing time between sting delivery and
removal reflects continuing pumping of venom into the flesh by the detached
sting, and it illustrates the importance of even short delays in removing
the sting.
The method of removal does not seem to affect the quantity of venom
received. This finding contrasts sharply with conventional advice on the
immediate treatment of bee stings. Probably this advice derives from a
misunderstanding of the structure and operation of honey bee stings. The
sting continues to inject venom, but it is the valve system, not contraction
or external compression of the venom sac (the wall of which contains no
muscle) that pumps the venom.
Our data indicate that the advice often given to patients--that they should
be concerned about how bee stings are removed--is counterproductive in terms
of minimising envenomisation. The method of removal is irrelevant, but even
slight delays in removal caused by concerns about the correct procedure (or
finding an appropriate implement) are likely to increase the dose of venom
received. The advice should be simply to emphasise that a bee sting should
be removed as quickly as possible. Of course the most important response to
bees defending their nests should be to get away from the vicinity of the
nest quickly. An alarm pheromone is emitted at the base of a honey bee's
sting;8 when detected by other bees it makes them more likely to sting, and
aids them in locating the victim. This effect is particularly important with
Africanised bees, since they are likely to respond in greater numbers to the
release of alarm pheromone than do European honey bees, with a consequently
larger number of stings. In such a situation, reaching safety is more
important than removing the stings immediately.
We thank Susan Trainor for help with observations, Vespa Laboratories for
providing the dried venom and Tim Visscher for constructive comments on the
paper. The US National Science Foundation (IBN 9120639) provided financial
support.
References
1 Riches HRC. Bee venom hypersensitivity update. Bee World 1989; 70: 12-18.
2 Schmidt JO. Allergy to venomous insects. In: Graham JM, ed. The hive and
the honey bee. Hamilton IL: Dadant and Sons, 1992: 1209-69.
3 Goddard J. Physician's guide to arthropods of medical importance. Boca
Raton, Florida: CRC Press, 1993: 349-59.
4 Mosbach H. Clinical toxicology of hymenopteran stings. In: Meier J, White
J, eds. Clinical toxicology of animal venoms and poisons. Boca Raton,
Florida: CRC Press, 1995: 81-86.
5 Riches HRC. Hypersensitivity to bee venom. Bee World 1982; 63: 7-22.
6 Mulfinger L, Yunginger J, Styer W, Guralnick M, Lintner T. Sting
morphology and frequency of sting autotomy among medically important vespids
(Hymenoptera, Vespidae) and the honey bee (Hymenopter, Apidae). J Med
Entomol 1992; 29: 325-28.
7 Snodgrass RE. The anatomy of the honey bee. Ithaca, New York: Cornell
University Press, 1956: 334.
8 Free JB. Pheromones of social bees. Ithaca, New York: Cornell University
Press, 1987.
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