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Bee stings and other allergic reactions

Discussion in 'Accidents and Near Misses' started by Ram, Nov 1, 2013.

  1. Ram

    Ram

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    I was just discussing allergies with a few different folks this week. How prepared are we for these issues? The canyons Illusions and Insomnia were just published here on this site. I was around for quite a few descents over the years and one common thread ran through each trip aside from the wonderful quality of the canyons. Multiple bee stings. Tom with 3, Aaron with 4, so and so with 2 (not me yet, ha, ha!). These canyons start up in ponderosa forests, so it isn't surprising that stings are a part of the equation. I wonder...are these Africanized bees? What if someone with an allergy got multiple stings? What about the folks that don't know they have an allergy?

    I think with so many folks going out with new partners, others introducing new folks to the sport, how thorough are we about checking for known allergies and do we have the tools to deal with an emergency? I just spent a week out, hours from the nearest care with someone with a peanut allergy. While out there I had forgotten about it and just remembered it now after not being out with the fellow for a few years. Of course he was careful to only eat what he brought, but still. Should he have told everyone about the allergy and any remedies he had with him? I try to tell my partners which pill will clot my blood or slow a runaway heart rate and where the meds are kept. Any stories out there? I think I will add the bee warning to the illusions and Insomnia beta thread.

    Tom on the way to Illusions
    [​IMG]
  2. ratagonia

    ratagonia

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    Africanized bees? You been watching (favorite news channel to mock) News lately?

    Africanized bees SWARM. They are very defensive and very aggressive. But their main attribute is that the pheromones released when one of the bees stings someone cause a bunch of other bees to swarm on the stingee and also sting. One does not get 2 or 3 or 4 stings from Africanized bees, one gets 100, 200 or 300 stings - or 1000s of stings. People who are not allergic might go into anaphylactic shock. Those who are allergic to bees are unlikely to survive, even with definitive care at hand (ie, in a city).

    Africanized bees were unsuccessful in entering the United States from Mexico. As I remember they are typically low-altitude creatures, and aggressive colonies in the USA were exterminated, resulting in the less-aggressive A-bees becoming predominant. Haven't heard much about it since 2002.

    http://www.hcn.org/issues/229/11291

    Tom
  3. townsend

    townsend

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    A small portion of the population is allergic to bee stings. It is hoped that they have been identified as such long before they go canyoneering and have taken the necessary precautions. While bee stings are uncomfortable to most (causing local irritation), the really serious cases involve anaphylactic shock, which can lead to difficulty breathing, etc. These individuals need to carry an epi(nephrine) pen, especially when involved in any activities that place them at risk for bee stings.
  4. Bootboy

    Bootboy Atwood Gear

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    Epi pens are short acting and are usually sold in two packs by RX only. While they'll buy you some time, It's also important to have Benadryl if help is more than a couple hours out. Everyone in the group should know basic airway management as it can save a life by simply positioning someone correctly, even with anaphylactic shock.
  5. Jolly Green

    Jolly Green

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    Finally, a medication related thread! As a pharmacist I get questions about allergic reactions often. In the ER, we use 4 medications for anaphylaxis or serious allergic reactions- Epinephrine, a steroid (ie Prednisone, Methylprednisolone), an anti-histamine (ie Benadryl), and an H2 blocker (ie Pepcid). As mentioned, Epipens are only available by prescription (and cost about $300 for a 2 pack) along with the steroids. If you have previous anaphylaxis, you should carry both of these. For the common canyoneer- I would recommend carrying Benadryl 50 mg and Pepcid 40 mg in your first aid kit as these are OTC and are dirt cheap. For those with known allergies (mild or severe), taking a dose of a non-sedating anti-histamine like Claritin or Zyrtec (both OTC) before going into the canyon could go a long way to lessening the symptoms should a reaction arise. There's my 2 cents.
    Tayres, Ram, Bootboy and 1 other person like this.
  6. Bootboy

    Bootboy Atwood Gear

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    What are you? Like a pharmacist or something? ;)
  7. canyoncaper

    canyoncaper

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    Ram, very interesting and timely conversation.

    I was recently stung by a bee while canyoneering here in Arizona. The canyon we were descending had small pools of water. Each pool of moisture attracted numerous bees. It was clear that they were in search of water. The bees did not react to us as we navigated around the pools. During an up climb, I began to sweat and I could feel moisture beads rolling down my face and neck. As I stepped upward, my helmet chin strap shifted, and I felt a sensation on the side of my neck. The best I can figure is that the bee was attracted to my sweat and stung me as it got trapped under my chin strap. At this section of the canyon, there were no other bees.

    The irony of the day was that as we left the car and entered the canyon, I asked who was carrying Benadryl besides me and let them know where mine was just in case I got stung - it figures that it was I that got stung. Over my life time, I have been stung at least twenty times. The last time I was stung was around 2007 and I had a stronger reaction than I was previously accustom to. Benadryl alleviated the discomfort, so, since then I have always carried Benadryl.

    Upon being stung, I moved to stable ground and immediately took three Benadryl within five minutes of the sting. My chest was already tightening and I was beginning to work to breath. The stinger was removed right away. We stayed put until the Benadryl kicked in - I was good until it started to wear off after about three and half hours, so I took three more Benadryl.

    I was stung on Sunday morning. Monday, I made my way to work, but I was having difficulty breathing and went home. Tuesday, I did make it through the work day, but after work I went to urgent care -- I had been taking three Benedryl every four hours since the sting. Every time the Benadryl began to wear off, my chest tightened and I began to had difficulty breathing. I let it go for so long because I was hoping to avoid having to take steroids. Urgent care gave me three days worth of steroids and a prescription for an epi pen.

    I did not know anything about an epi pen until this incident. When I told my canyoneering partners about the benadryl etc at the beginning of the canyon, one person said that they had a pen with them. It was not until Clint got after me on FaceBook, did I do some research and understand the use of the epi pen. I now have two pens. Each one is a one-time use. One is supposed to be for home and the other is supposed to travel with me. They were really expensive!

    It appears that I'm one of those people that becomes more sensitive to bee stings each time I get stung. My future plans will be to AVOID bees! Also, I will need to be actively communicating with my venturing partners as to my health issue.

    In preparation to respond to this thread, I have done a fair bit of research, and I have queried a number of people with varying breaths of knowledge. What I've learned thus far, is that I need more education.

    Felicia
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  8. Bootboy

    Bootboy Atwood Gear

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    An Epi-pen is like an avalanche beacon. Expensive, you carry it everywhere, and hope you never have to use it; but when you need it, suddenly the price becomes irrelevant.
  9. spinesnaper

    spinesnaper

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    $300 for a pair of epipens. This is what is wrong with health care. First the epipen is a very convenient and relatively fail-proof means of injecting epinephrine in a life threatening emergency. If you have a personal history of anaphylaxis, these can be life saving. Personally I get anaphylaxis to lobster. Fortunately lobsters do not inhabit canyons. Having said that, there is a much less expensive means of administering epinephrine if you have a physician friend who can supply the basics. The epi pen administers a 0.3 mg dose of epinephrine and the epi jr pen 0.15mg. A 1 mg ampule of epinephrine cost about $1.00. This can be drawn into a 3 ml syringe and injected with a 22 gauge. The components should be stored sterilely and protected from damage in your kit bag. The dose is .3 to .5 mg. So that means that half or one third of the ampule is injected. Also you have to be prepared to give an injection. There is no substitute for training. If mastering the skill needed to do this seems beyond you, now you understand why the company can get $300 for an epipen.

    Ken
  10. Bootboy

    Bootboy Atwood Gear

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    Because it's soooooo expensive to put it into an auto injector ;)
  11. Mountaineer

    Mountaineer Is that an X slot?

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    What is the shelf life on these? I hear that medications lose their effectiveness after a period, as I have an older one in my kit that may need to be replaced.
  12. canyoncaper

    canyoncaper

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    The expiration date is on the pen. It looks like they are about a year.

    Felicia
  13. Jolly Green

    Jolly Green

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    There are actually 3 expiration dates I go by. The pharmacy puts a label on them that shows an expiration date one year out from the day the pharmacy fills it. Ignore this. Felicia mentioned the official expiration date printed on the injector itself- this is officially when you should throw it away. Most medications are good beyond this expiration date. Each manufacturer tests the potency of their products at a certain cutoff date- usually 2-3 years out, and this is the date they can guarantee the same potency. With that being said, considering the substantial cost involved with an Epipen, I would personally trust it for a year beyond the listed date as it is likely to maintain that potency for some time.
  14. canyoncaper

    canyoncaper

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    Very interesting.

    Although we are talking about bees in particular here, I'm learning that it is the managing of the anaphylaxis reaction that is the crux of being prepared. The message that I have been receiving is that a person needs to take personal responsibility and get the education to manage their particular anaphylaxis reaction directly from medical advisors.

    I'm not comfortable giving 'advice' on the internet about this subject that I'm not qualified, but I was told that Benadryl should NOT be taken at times because it interferes with further medical treatment under certain circumstances. True? Not true? Opinions?

    Ram, thanks for starting this thread. It has prompted me to pursue conversations and research.

    Felicia
  15. Jolly Green

    Jolly Green

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    Amen to just about everything you said. A few words of advice if you are fortunate enough to have a doctor friend to share the Epi ampules with you. These too expire like Epipens. Ampules are much more fragile than Epipens and should be stored in some serious armored packaging if you are taking it through a canyon. I like to have an alcohol swab or two with me- first to clean the area you are going to inject and second to break open the ampule as it is glass and will cut you easily. You NEED (not a suggestion) a 0.5 micron filter needle to draw the Epi out of the vial as the ampule breaks into thousands to tiny glass particles, otherwise you will be injecting glass shards into your skin and increasing the risk of infection greatly. I would suggest a 1 ml syringe as it is much easier to get the right dose. You can use anywhere from a 21 gauge to a 28 gauge needle as it can be given in the muscle or subcutaneous tissue. Last thing, do not draw it up beforehand and carry it around in the syringe. The expiration date is only valid if you leave it in the packaging- out of the packaging it is only good for 30 hours.
  16. Jolly Green

    Jolly Green

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    Great question. If you experience a reaction at your house where medical care is likely minutes away, this may be true, but in very few instances. If you are in a canyon where medical care is likely hours away, I would take Benadryl every time.

    There are several phases to allergic reactions- while Benadryl may help control the initial reaction, it usually only lasts 6 hours or so and does not stop the delayed phases of reactions that can continue hours and even days later- that is what steroids help with.
  17. Jolly Green

    Jolly Green

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    This is ideal if you have allergies. Please do so.

    The only reason I am posting any sort of "medical advice" on this forum is because I get to see allergic reactions every day and I know that a lot of people will not go to their doctor and spend the money to preemptively prepare for something like this. Hopefully, if canyoneers get in the habit of carrying cheap meds like Benadryl and Pepcid that only require a simple trip to the grocery store to obtain, we won't add to Slot Machine's "Death Thread" he posted on the other forum.

    Sorry for taking over this thread. I hope someone learned something.
  18. canyoncaper

    canyoncaper

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    Your participation in this thread has been awesome!

    My comments are directed towards myself - I need to get out and get more information. Although I have not been stung since 2007, I have had some really bad reactions to other irritants such as poison oak over the last couple of years. An educated, more aware 'me', should have known that a bee sting would be more dangerous now. Until now, I did not 'tie together' my anaphylaxis to other 'stuff' would manifest itself in a bee sting. Looking back, hindsight is 20/20 and I can see that my reactions have intensified - this should have been a warning. I hear it now. I'm willing to throw myself under this bus if it means that someone, just one person, is listening and it helps them.

    Felicia
  19. canyoncaper

    canyoncaper

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    Another branch of this bee road that I have been exploring is: What do you do if you attract a swarm of AZ bees?

    Beyond the response "don't do it!!!!", suggestions/ideas?

    Felicia
  20. ratagonia

    ratagonia

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    I'm studying for my WFR re-cert, just got to that chapter: source: Wilderness and Rescue Medicine, 2nd Edition, 2007. Isaac and Johnson. Chapter 9.

    Recommendation: in the backcountry, carry 3 doses of Epi. Try to get the Twinject injectors which has two doses, and might cost the same. (As I remember, the twinject goes out the same needle, so it would only be used by one person for both dosages - though, clearly, giving someone a tincture of your blood is better than watching them die.)

    Benedryl: 25-50 mg by mouth immediately. (Felicia - taking 3 rather than 2 probably does not improve the outcome.) Benedryl blocks the effect of the histamines at the receptor site, a different mechanism than the Epi and the Prednisone.

    On an overnight trip, would also want to have Prednisone (40-60mg/day) on hand. Helps prevent the biphasic (second anaphylactic shock) reaction.

    Tom
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