Contributed by Ellen Wright

It seems that whenever a community discusses urban beekeeping, the overriding concern is the fear of being stung by a bee, and the possibility that the sting might be deadly.

The data on the true risk of a deadly allergic reaction to an insect bite gives overwhelming support to the conclusion that the fear of a bad reaction to a bee sting is far greater than the actual risk.

Even though the fear of deadly allergy to a bee sting is not warranted by the data, the fear is still real and needs to be addressed respectfully. What follows is a summary of data on bee stings drawn from highly reputable sources. All of the following information is drawn from academic , medical and government sources and all resources are cited.

Photo courtesy BeeGirl.org

SUMMARY:

“Anaphylactic reactions from stings leading to death are so rare that there is little reason to factor them into decisions about honeybee policies…” ( FAQ – Bee Sting Allergies and Municipal Regulations )

• Only 3% of adults and 1% of children are at risk of a systemic allergic reaction to insect stings (bees, wasps, hornets, fire ants etc.). It is very rare for that type of reaction to be fatal: 40 fatalities in a population of 316,500,000 people in the US in 2013.

• .Life threatening reactions to bee stings are extremely rare, and deaths from those reactions even more rare.

• Children are at LESS risk than adults.

• It is “nearly impossible” for someone to die from being stung the very first time. Most life threatening reactions happen after repeated stings (beekeepers are at the most risk!) .

• Wasp stings are often reported as bee stings – the data cited are for all insects in the wasp/bee family.

• Developing a localized rash or swelling is a normal reaction to any insect bite from wasps, honey bees, hornets, ants, bumble bees and other members of the hymenoptera class of insects.

• Allergy desensitization treatments are effective in people with large local reactions. EpiPens should be carried by people who believe they may have a severe reaction.

RESOURCES:

It is estimated that potentially life-threatening systemic reactions (called anaphylaxis) to insect stings occur in 0.4% to 0.8% of children and 3% of adults. In the United States, at least 40 deaths are attributed to Hymenoptera stings each year (Stinging insect hypersensitivity: A practice parameter update 2011.

The Journal of Allergy and Clinical Immunology. Volume 127, Issue 4, Pages 852-854.e23).as cited by the American Academy of Allergy Asthma and Immunology

Children generally are considered to have a more benign course after insect stings, largely because they usually have only cutaneous systemic reactions.

Stinging Insect Allergy David B. K. Golden, M.D., Johns Hopkins University School of Medicine, Baltimore, Maryland Am Fam Physician. 2003 Jun 15;67(12):2541-2546.

By contrast, dog bite fatalities are about at par (slightly less averaged annually) with insect bite fatalities, but children are at higher risk of fatality in a dog attack.

Dog Bite Related Fatalities published by the National Canine Research Council

Average annual deaths in the US in 2013 (out of a population of 316,500,000) due to:

•        40 – Hymenoptera insect stings (honeybees, bumble bees, native bees, wasps, fire ants)
•        42 – dog bite fatalities in 2014. 26-42 annually from 1979- present depending on source. CDC data only available up to 2011.
•        51 – lightening
• 33,804 – car accidents
• 56,097 – flu

Insect Hypersensitivity Table published by American Academy of Allergy Asthma and Immunology
Dog Bite Fatalities published by the Dogs Bite.org (reliability less than CDC)
Dog Bite Related Fatalities published by the National Canine Research Council
Non-Fatal Dog Bite Related Injuries published by Centers for Disease Control and Prevention
2013 Mortality Multiple Cause Micro-data Files published by Centers for Disease Control and Prevention
Fatality statistics published by the National Weather Service Lightening Safety

Dr. David Golden, associate professor in the Division of Allergy and Clinical Immunology at Johns Hopkins University’s Medical Institute (and author of the study cited above) , 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.

Insect stings cause 3 kinds of reactions:

• Majority   – Transient local inflammation – pain itching and swelling at the sting site are normal responses to stings.
• Minority – Large Local Reactions – severe swelling (8 – 10 inches in diameter) that  lasts 2 – 7 days
• Rare– Systemic reactions, or reactions that involve the systems of the body. There are several kinds of systemic reactions – the most rare, but most severe is anaphylactic shock.
  • Children have a lower frequency of is anaphylactic shock than adults.
  • Even if a person does go in to anaphylactic shock, they rarely die.

Disease Summaries: Allergy to Insect Stings and Bites World Allergy Organization, November 2008

Dr. Scott Camazine, writing in the Bulletin of the Entomological Society of America , says that

“Allergic reactions to penicillin kill seven times as many [people as bee stings], and lightning strikes kill twice as many. In contrast the nation’s largest killers are cardiovascular disease (100 people per hour) and auto accidents (one person every 10 minutes). Ironically, one is more as risk of dying in an auto accident on the way to the hospital to be treated for an allergic reaction that of dying from the sting that produced it.”

Cited in Storey’s Guide to Keeping Honey Bees   By Richard E. Bonney & Malcolm T. Sanford, 2010, Storey Publishing.

Also cited in Institute of Food and Agricultural Sciences, University of Florida, Florida Cooperative Extension Service, 1988

“During systemic shock a patient may think he is going to die, as may his family or physician. What people need to know, therefore, is that the vast majority of humans, particularly if aged under 25, will quickly recover.”

Dr. Howard S. Rubenstein, The Lancet

FAQ – Bee Sting Allergies and Municipal Regulations 

This paper contains a number of good sources for data and is a good summary of the information. The conclusion reached is:

Punchline: There’s no evidence on the impact of beekeeping regulations on human safety. Likewise, anaphylactic reactions from stings leading to death are so rare that there is little reason to factor them into decisions about honeybee policies — rather, decision-makers should be aware of the nonfatal but more common problems that can accompany possible anaphylactic reactions to insect stings. 

Howard County Beekeepers in Maryland have a good overview of the different reaction to bee venom in their article Bee Stings and Allergic Reactions. The information is  based on an authoritative review published in 1982 by Harry R. C. Riches, “Hypersensitivity to Bee Venom,” Bee World, Vol. 63, Number 1, pp. 7-72. Dr. Riches.

In Britain most reactions are caused by stings from wasps (the Vespula species) rather than from bees. Patients allergic to wasp venom are rarely allergic to bee venom.

In contrast, allergy to bee venom occurs mainly in people who have been stung frequently by bees. Thus almost all patients who are allergic to bees are beekeepers or their families, or sometimes their neighbours.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1113072

First Aid for Stings

Honey bees – but not other bees or wasps – generally leave the stinger embedded in the skin. Remove the stinger as soon as possible since some additional venom may be pumped by the venom sac. Honey bee stings are best removed by scraping (not crushing) the stinger with a finger nail or knife blade.

Localized swelling and pain are typical reactions to a sting by a wasp or bee. In most people, these symptoms gradually disappear within a few hours. Some swelling, itching and pain are all normal reactions and do not necessarily indicate a systemic reaction to the venom of the sting.

Treat the sting site with an antiseptic to prevent possible infection. Cool lotions or compresses can help relieve pain and swelling. Various materials applied to the sting site may also reduce pain – crushed aspirin, meat tenderizer and urine are among those that have been suggested. If many stings are received oral antihistamines can sometimes reduce swelling and itching.

A small percentage of the U.S. population (approximately 1 percent) develops hypersensitivity to either bee or wasp venom following repeated stings. A systemic allergic reaction can involve difficulty in breathing, dizziness, nausea and development of hives. These symptoms may require immediate medical attention from a physician.

 The incidence of systemic reactions to Hymenoptera venom is approximately 3% in adults. Although children are stung more often than adults, systemic reactions occur in only about 1% of children younger than 17 years, and many of these reactions are relatively mild.