A tale of stings and reactions

Dr Jon Tuppen Sproughton

Alfred Dürer, 1514: Eros, Venus and the bees

"Eros stung by a bee, when he inhaled the pleasant fragrance of a rose, went crying to take refuge in the arms of Venus," Dear mother, I

die, have mercy on me, a flying snake bit me painfully cheek "

Anacreontic singing, 6th c. av. AD "

What is this?

Melittin – 26 amino acid peptide

Is this an allergic response?

Bee Venom: Composition, Health, Medicine: A Review Stefan Bogdanov http://www.bee-hexagon.net/files/file/fileE/Health/VenomBookReview.pdf

Sting components all designed to break down normal permeability

The recognition

system-

seek and destroy

....then things get a bit complicated

Anaphylaxis – what is it?• Acute onset of an illness (minutes to several hours) with • involvement of the skin, mucosal tissue, or both (e.g.,

generalized hives, pruritus or flushing, swollen lips/tongue/uvula) • Respiratory compromise (e.g., dyspnoea, wheeze–

bronchospasm, stridor, reduced PEF [peak expiratory flow], hypoxemia)

• Reduced BP (blood pressure) or associated symptoms of end-organ dysfunction (e.g., hypotonia [collapse], syncope, incontinence)

• Persistent gastrointestinal symptoms (e.g., crampy abdominal pain, vomiting)

• Sense of Impending doom

Clinical features of systemic reactions to bee or wasp stings

Bee (11) Wasp (43)

Generalised pruritus 6 24Urticaria 6 24Angioedema 5 26Laryngeal oedema 5 11 }Asthma 4 20 } 72%Gastrointestinal 6 15Visual disturbances 3 7 }Hypotension without LOC 5 16 } 88%Loss of consciousness 3 15 }

Ewan 1984

UK cases of fatal anaphylaxis

Where are people most likely to get stung?

n=278

How to recognise anaphylaxis

How to recognise anaphylaxis

How to recognise anaphylaxis

Anaphylaxis – what to do if it happens.

• Shout for Help!! Don’t take chances – phone 999 – remove sting

• If the person has medication – give it- – Antistamines– Steroids

• Use Adrenalin auto-injector sooner rather than later i-m in outer thigh– Repeat x 1 after 5mins if no improvement

• Get patient to hospital for observation

How to give i-m Adrenalin

Thank You