When One Bee Sting is Your Last

About 40 people die each year from stings, and half don't know they're allergic.

July 22, 2009, 3:18 PM

July 23, 2009— -- Millions of Americans live out their lives unaware that they are severely allergic to bee and wasp stings, so much so that a single sting can send them into anaphylactic shock and cause death.

That was apparently the case for Ray Shaw, a former Dow Jones & Co. president and Wall Street Journal publisher, who died last week at the age of 75. His family said he had no known allergy to stings, yet he was found dead in his garage from a single wasp sting.

College freshman Helen Tobin has practically grown up with an EpiPen in her pocket after suffering multiple severe allergic reactions to bee stings.

The 18-year-old from Des Moines, Iowa, was stung for the first time when she was only 4 when a bee sting on her neck made it swell to the size of a "balloon."

She has been stung four times since, and was never formally diagnosed with having a venom allergy, but was immediately prescribed the autoinjector, EpiPen, a dosage of epinephrine used as emergency treatment for life-threatening allergic reactions.

"When I get stung, the feeling is just panic because I don't know exactly how my body will react," Tobin said.

According to government statistics, about 3.3 percent of adults will experience anaphylaxis after an insect sting and there are 40 to as many as 100 deaths annually from insect-sting-related anaphylaxis. Anaphylaxis is a severe type I hypersensitivity allergic reaction in humans and other mammals.

Dr. David Golden, associate professor in the Division of Allergy and Clinical Immunology at Johns Hopkins University's Medical Institute, told ABCNews.com it's "nearly impossible" for someone to die from being stung the very first time, although any sting can trigger the development of the allergic sensitivity.

Commenting on the Shaw case, Golden said, "It's likely that he had one sting before because the allergy can be dormant in your system for that long. He may not remember."

Golden said there have been about 40 sting deaths per year based on 10-year national statistics. The statistic was confirmed in a similar study done in the 1990s by physician David Graft.

"About 3 percent of adults have had a history of one systemic reaction. On the other hand, almost none of them ever told their doctor about it. Of these 40 people a year, how many of them knew? The answer is about 50 percent."

Unlike allergies such as asthma, there is not a clear pre-screened test for insect sting reactions if someone has never been stung before, although an allergist can conduct a skin test, which can show if the patient has a strong negative indication.

During skin testing, a tiny bit of bee venom is pricked into the skin of the arm or upper back. If a raised bump develops, the test would indicate a positive allergic reaction.

But as for routinely testing people for the allergy, Golden says that wouldn't be practical or desirable.

"There's no screening test that we could or should do," Golden said. "The rule among allergists is that we shouldn't test people unless they've had a clearly systemic reaction."

Government statistics also indicate that among people who have symptoms of anaphylaxis after being stung, there is a 60-70 percent chance that future stings will cause a similar reaction. The chances of a reaction with a future sting will decrease over time, but still remains at about 20 percent many years after the last sting.

According to Dr. Richard Weber, a physician at the National Jewish Health Center in Denver, Colo., that initial reaction to a sting may be as severe as it gets. "Most people tend to have the same kind of reaction, same severity the next time."

Bee venom, when injected in small amounts, appears to have unexpected benefits in lessening the severity of a sting.

Venom therapy, which was developed in the 1970s at Johns Hopkins University, can help treat non-fatal, but serious allergic reactions to insect stings.

"Once it's (the allergic sensitivity) in your system, any future sting could cause a systemic reaction," said Golden, who worked with a team in the venom therapy study. "Clinically, a lot of people have been sensitized. Having an allergy in your system is like having a dormant allergy. What makes it start to cause problems is not known."

In a study, each volunteer was given an initial sting to measure his/her response; then 19 members got venom shots once a week over a summer and 10 received no shots.

The control group members' responses to stings did not change, but those who were injected with the venom showed 50 percent less swelling on average.

After the first summer, both groups received venom therapy for up to four years. Following two or more years of injections, both groups had 60 percent smaller swellings on average than initial treatments.

"Most people who do get these large allergic swellings don't need [venom therapy] unless they get frequent and unavoidable stings, but for those who do suffer reactions every year, it does provide a very good level of protection," Golden said.

Bee sting allergy symptoms often begin with a dry cough, according to Penn State's Milton Hershey School of Medicine. The sting area begins to itch and swell and as symptoms progress, the patient begins to sneeze and wheeze, and develop hives that itch.

These symptoms may be warning signs of a dangerous condition called anaphylaxis. Symptoms include sudden anxiety and weakness, difficulty breathing, tightness in the chest, very low blood pressure, loss of consciousness, and shock. Anaphylactic shock can occur within minutes and result in death. A patient in anaphylactic shock needs immediate medical treatment.

To minimize the risk of being stung, don't use flowery colognes, soaps, or lotions, or wear brightly colored clothing, which attract bees. If a bee is near you, move away. Do not swat at the bee, which may aggravate it. Make sure any bee or wasp nests around your home are removed and destroyed.

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