My dad got stung by a bee, and is mildly allergic. What are the tradeoffs involved in deciding whether to have him go the the emergency room?
post by Eli Tyre (elityre) · 2020-04-18T22:12:34.600Z · LW · GW · 6 commentsThis is a question post.
Contents
Facts: Questions: None Answers 8 elityre 1 peleion None 6 comments
Facts:
- My dad is 61, and reasonably healthy.
- 20 minutes ago, he got stung by a bee, on the ear.
- When he's been stung (or bitten by ants) in the past, the area around the sting/bite has swollen considerably, but he has never gone into anaphylaxis.
- However, I'm concerned that this situation has a larger risk of obstructing the airway, simply because the sting is on his head.
- We removed the stinger within 5 minutes of being stung, and he took a dose of Diphenhydramine (Benadryl).
- He lives in Maricopa, Arizona, US, where (according the the John Hopkins Cornavirus dashboard), there have been 2,491 total COVID-19 cases, and 70 deaths.
Questions:
- Does anyone know of figure such as "If the patient starts do develop symptoms in their mouth or throat, their risk of full blow anaphylaxis is [X]%?"
- I think that number in particular, is pretty crux-y.
- Which resources should I be referring to.
- How should I be weighing the risks of bringing him to the emergency room in light of the current pandemic?
[Update: it seems like the base-rate of anaphylaxis from bee stings is 3%, when anaphylaxis occurs, it usually starts within within a few minutes.
The key question I have left is if "large local swelling", can block the air ways when it the swelling is on the head or face.]
Thank you!
Eli
Answers
After an hour of research:
It seems like the base rate of anaphylaxis from bee stings is about 3%. Anaphylaxis, if it occurs, usually starts within minutes of the exposure to the allergen. (It can occur as much as 24 hours later, but this is "rare". I don't know how rare, quantitatively.)
Anaphylaxis is the result of a "global" or "systematic" reaction, as opposed to a "local" reaction, namely swelling around the area stung.
There is some risk that a local reaction can cause swelling of the throat blocking the airways, but since 43% of bee stings are on the face and neck, and severe respiratory distress is rare, this is is very uncommon. It seems like this is only a concern when the person is stung inside the mouth or throat.
The simple answer is observation.
As long as there's no difficulty swallowing or breathing then the reaction is local only. People with true anaphylaxis experience facial/tongue/mouth swelling and respiratory symptoms regardless of where the sting is.
Any respiratory or oral symptoms should prompt an immediate trip to the hospital.
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comment by KatjaGrace · 2020-04-22T21:22:59.106Z · LW(p) · GW(p)
In such a case, you might get many of the benefits without the covid risks from driving to very close to the ER, then hanging out there and not going in and risking infection unless worse symptoms develop, but being able to act very fast if they do.
comment by Eli Tyre (elityre) · 2020-04-18T22:23:15.265Z · LW(p) · GW(p)
From medline plus:
Most severe allergic reactions occur within seconds or minutes after exposure to the allergen. Some reactions can occur after several hours, particularly if the allergen causes a reaction after it has been eaten. In very rare cases, reactions develop after 24 hours.
Anaphylaxis is a sudden and severe allergic reaction that occurs within minutes of exposure. Immediate medical attention is needed for this condition. Without treatment, anaphylaxis can get worse very quickly and lead to death within 15 minutes.
It seems like if you don't have a severe reaction, shortly after the sting, anaphylaxis is pretty unlikely?
But I think that this is with allergens in general, and according to medical news today, swelling from bee stings can occur gradually over the course of 24 or 48 hours.
comment by renato · 2020-04-18T23:30:50.255Z · LW(p) · GW(p)
I'm glad you could already find the answer for it, and I hope your dad gets better.
I'm writing just to say something that has worked for me (I'm also allergic). When I was stung by a wasp, I found that applying a cold compress reduced the swelling considerably, and I recovered in a matter of hours. When it happened before and I didn't use the cold compress, I remember it taking days to recover, and I could not walk properly while it was swelled. Both times I was stung on my ankle.
comment by Eli Tyre (elityre) · 2020-04-18T22:59:34.725Z · LW(p) · GW(p)
This paper seems to be exactly what I'm looking for. It deals specifically with airway obstruction as a result of local swelling.
Approximately 43% of Hymenoptera stings occur in the head and neck region, but only nine cases of Hymenoptera stings in the oropharyngeal region have been described. None of these victims experienced systemic symptoms, but all of them developed some degree of localized swelling. The majority had uneventful recoveries after treatment with a combination of anti-histamines, corticosteroids, and epinephrine. One patient required nasotrachealintubation because of theseverity of his airway swelling. None of the stings resulted in death.
comment by Eli Tyre (elityre) · 2020-04-18T22:49:36.986Z · LW(p) · GW(p)
From this factsheet:
Patients often worry about threat to airway with large local reactions, but stings on the face or neck cause mainly external swelling, and airway involvement is unlikely or would occur slowly.
comment by Eli Tyre (elityre) · 2020-04-18T22:30:08.605Z · LW(p) · GW(p)
According to this paper,
Anaphylaxis to insect stings has occurred in 3% of adults and can be fatal even on the first reaction.
So that seems like a good prior to adjust from.