I love bees. I thank them and cheer for them as they buzz from one of my fruit trees to the next, making the harvest possible. For some people though, usually minor problems like bee stings and usually harmless foods like peanuts bring a risk of sudden death from a serious allergic reaction.
We’ve all heard the stories. People dying after kissing someone who’d eaten peanuts, or being arrested for opening a bag of peanuts on an airplane. “The next bee that stings you will kill you.” Parents frantic because they can’t afford $600 EpiPens to stop a killer allergic reaction.
This bee is making my apple crop possible. If I were allergic and really annoyed her, she might kill me.
Worse, some of those stories are actually true. Anaphylactic shock (a type of allergic reaction) is a dangerous medical crises that occurs when someone’s immune system takes the ‘nuclear option’ in response against an otherwise harmless foreign protein. It’s the equivalent of getting rid of a mosquito on your friend’s forehead by slamming the mosquito with a sledgehammer.
We recorded a podcast that accompanies this article:
There are very many foreign proteins that might cause such reactions, so it’s not entirely predictable who will respond to what. Most people will (thankfully) never have this kind of reaction to anything. Others might have several different triggers. One doesn’t react this way the first time the foreign protein is encountered (it takes training to make the immune system that aggressive), so the anaphylactic allergic reaction can pop up by surprise. Some proteins are more likely to cause reactions than others: peanuts, bee stings, and shellfish/shrimp are particular villains.
The best response to an anaphylactic reaction is clear: Inject epinephrine and head to the emergency room. This is not exactly a prepper option in a lot of emergencies. What can a prepper do if someone they care about is having an anaphylactic reaction?
I’m not a physician, these are not recommendations. These are some thoughts from a person who knows something about how bodies work. (I’m a physiologist.)
What does anaphylaxis look like? (1,2)
The allergic reaction starts quickly; within minutes of skin exposure (such as a bee sting) or half an hour of eating it. The affected area (mouth and throat if the protein was eaten) become warm, itchy, tingly, swollen. The hair in the area may stand on end. Affected children may quit playing, show behavior changes and are more likely to have a bathroom accident. Breathing becomes difficult, with stridor or wheezing (harsh grating or whistling sounds with each breath).
Confusion and stupor are common (stupor is when someone is less responsive and tends to just sort of sit and stare) and seizures may occur. The person often experiences what they call ‘a feeling of doom’. (I sure am having a feeling of doom if I have anaphylaxis without good medical care at hand!)
If there is epinephrine around, now is the time to use it (1)
People who are known to have this kind of allergic reactions are urged to always carry injectable epinephrine such as an EpiPen — or two actually, since more than one dose is often required. If it’s available, it’s best to use it as soon as you’re sure a system-wide reaction has started. Fainting, breathing difficulty, facial swelling, and a rash that is all over the body instead of just at the exposure site are system-wide reaction signs. Wait too long, hoping to save the dose, and the reaction can get too strong for the epi to save them.
Wilderness med packs?
Some very well-equipped wilderness med packs also contain injectable epinephrine. It’s hard to get this done, as this stuff is available by prescription only. If you are lucky enough to have some, be aware they’re not kidding about the expiration dates on epinephrine. It really does lose potency faster than many drugs, especially in extremely hot conditions.
0.3 mg of epinephrine, usually supplied as a 1:1000 dilution so that’s 0.3 ml injected, is the usual dose. It can be injected into the muscle or under the skin, and the outer upper arm or the thigh are the usual sites. More doses can be given every 5 min if the person’s getting worse, or 15 min if they’re not getting better. (1)
Persons with allergies may also have rescue inhalers on hand. Those are filled with beta-2-adrenergic agonists – drugs that mimic some of the critical functions of epinephrine. Having the person use their inhaler is recommended if there are any respiratory symptoms. (2)
What else can be done? (1,2,3,4)
Anaphylactic allergic reactions can take a lot of different courses. Some will resolve without treatment, or with minimal treatment; others are fatal even with good treatment. Some persist for hours; others resolve more quickly. About 30% are biphasic, meaning the symptoms spike, recede for awhile, then recur (always within 72 hrs). In other words, you don’t know what you’re going to get, so you do what you can and hope/pray for the best.
If it was a bee sting, getting the stinger out as quickly as possible, without injecting more of its venom, is critical. Scraping the sting site with a dull knife blade or a credit card works well. Forceps (tweezers) grabbing the stinger at the skin surface works. Fingernails can do the same trick but try not to squeeze the stinger bulb.
If it was skin exposure of any kind, cooling and elevating the exposure site can slow the entry of the protein and reduce the intensity of any reaction it sparks.
Position matters
When someone’s having a allergic reaction, putting them in the right body position can support their breathing and circulation. If there’s breathing trouble, having them sit upright or at an incline rather than flat often helps. If they are pale, sweaty, feel faint, or have passed out, that’s a circulation problem. Raising the legs above the level of the heart lets the core of the body keep more of the available blood flow.
Since this an allergic reaction, oral antihistamines that are often provided for more mundane allergic reactions also have some value. Many sources suggest diphenhydramine (Benadryl); for an adult at 50-100 mg every 4-6 hr (1). Chlorpheniramine (Chlor-Trimeton) may also be used (4). Ceterizine (Zyrtec) can be given at 20 mg for adults, or twice the usual child’s dose to children (2).
Diphenhydramine should be in every first aid kit, imo. It can help in some very dangerous situations. My bottle’s already helped prevent a trip to the ER for a friend.
If there happens to be some oral corticosteriods on hand, they may be helpful too. (1,2). Prednisone is the most common example of this class. People with other immune problems or organ transplant recipients may have some of this about.
Sting kits
Kits like the one below are commonly available. They don’t contain epinephrine injectors, which would be ultra-useful but are prescription only. They do often have antiseptic wipes (never a bad idea), topical anesthetic (can increase comfort post-sting), and venom extractors. The literature on venom extractors is quite mixed. The consensus is No for the kinds of snake bites one gets in North America (read here for more) and less convincing in any direction for insect stings. They might help and probably won’t do much harm. I don’t bother to pack one.
Sting kits do not contain epi injectors. They do often have antiseptic wipes, venom extractors, and topical anesthetic.
Avoiding allergic reaction triggers
All these tips may help; may save a life even; but they are very far from a sure thing. Much better to avoid the allergic reaction triggers when possible. The approachif it’s a food item: Don’t eat it. <–Brilliant, right?
Bees and wasps are also common initiators. In an emergency situation, just staying inside is not necessarily an option. Even if has never been allergic, getting stung multiple times can trigger a reaction, so the fewer stings one gets the better. <– also Brilliant! I just bring that up because some bees are social and many attacks come when the insects’ home is threatened. That means if you’ve just stirred up a hornet’s nest, it’s time to Bravely Run Away!
If there are bees/wasps/hornets around, don’t swat and agitate them; just leave. Keep your mouth shut, too, as a sting in there is much more serious.
Queen wasps often nest in cavities, such as boots. You can store your bug-out boots with the neck of one stuffed in the neck of the other, and check the interiors before you stick your feet in.
Don’t leave open drink containers around in bee territory then drink from them without checking. Bees can be attracted into the fluid (especially if it’s sweet) and sting when you try to drink them. Who can blame them for that?
Bees and wasps are also less attracted by white clothing, and solid colors are less attractive than floral prints. Scented body care products and deodorants attract them. Sweat does too, but to a lesser extent.
We need bees, they’re important food production partners. It’s just a case where good boundaries make good neighbors.
1) Protocol 6: Anaphylaxis and Epinephrine. (2018) Center for Wilderness Safety: Wilderness Medical Protocols.https://www.wildsafe.org/resources/wilderness-medical-protocols/anaphylaxis-wilderness-medical-protocol/
2) Bilo, M. B., Cichocka-Jarosz, E., Pumphrey, R., Oude-Elberink, J. N., Lange, J., Jakob, T., . . . Rueff, F. (2016). Self-medication of anaphylactic reactions due to hymenoptera stings-an EAACI task force consensus statement. Allergy, 71(7), 931-943. doi:10.1111/all.12908
3) Laskowski-Jones, L. (2006). First aid for bee, wasp and hornet stings. Nursing, 36(7), 58.
4) Bee Sting. (Aug 2017). Mayo Clinic patient care and health information. https://www.mayoclinic.org/diseases-conditions/bee-stings/diagnosis-treatment/drc-20353874