Benadryl still best defense in halting reaction to stings

Published 12:00 am Friday, July 13, 2012

By Karissa Minn
SALISBURY — By taking Benadryl by mouth after a bee sting, Patricia Vaughan did exactly what she should have, a local doctor said Friday.
Dr. Thom Trowbridge, an emergency medical physician at Rowan Regional Medical Center, said that should be enough for the “vast majority” of people. But for some, the allergic reaction is too fast and too strong.
Vaughan, a retired teacher and Salisbury native, died Wednesday after being stung three times by yellow jackets.
Her husband, Keith, said neither of them knew the extent of her allergy. Vaughan had been stung before, but it only caused some swelling.
Trowbridge said it’s not unusual for an allergic reaction to get worse after the first sting.
“I think it would be very unusual if somebody had 100 bee stings and then had one that was a lot worse,” he said. “The first time you experience it, sometimes the reaction isn’t as severe. Most times, the second time and thereafter, it’s usually about as severe as it’s going to get.”
Vaughan’s husband said she seemed fine after the stings, but after leaving her alone for a few minutes, he found her collapsed on the floor unconscious. She was rushed to the hospital and given numerous EpiPen injections, but it was too late.
Right after she was stung, Vaughan had applied some topical Benadryl to her skin and took a Benadryl pill (which also can be found as generic diphenhydramine).
Without knowing her symptoms, Trowbridge said that’s the same advice he would have given.
“Everybody should have Benadryl in their household medicine kit,” he said. “Liquid is the fastest way to get the Benadryl into your system, but don’t delay taking pills to go get the liquid. You’re probably talking about a 10-minute difference.”
For most people, that’s the most they need to do.
The body’s response to bee stings can be as mild as a little bit of pain, itching and redness where the person got stung. Other reactions can include swelling at the site or even a larger localized area, like a whole hand.
Trowbridge said people should call an ambulance when they have an “all-over” allergic reaction — widespread swelling (especially of the nose, tongue or throat), a strange sick feeling, trouble breathing or dizziness. Topical antihistamines won’t help these severe symptoms.
A widespread rash is also a warning sign if the cause is a bite, sting or other external exposure.
“If you get stung in one area and you get a reaction all over your body, you’re prone to much more severe allergic reactions,” Trowbridge said. “Those people have to be much more careful.”
That kind of systemic response is called anaphylaxis, Trowridge said. It can be fatal when it causes someone’s airway to swell or stresses the body to the point of organ failure.
He said anyone who has experienced a severe reaction to any type of allergen should see a doctor. They will likely be advised to carry an epinephrine auto-injector like an EpiPen, he said, which can ease those reactions quickly.
Trowbridge said most people who have severe allergies are already seeing a doctor to manage them. Extreme, sudden cases like Patricia Vaughan’s are rare, he said.
“I’ve seen hundreds of allergic reactions (in the emergency department), but I’ve never seen one that’s really severe,” he said. “I’ve seen systemic reactions, but if we treat them quickly, they’re fine. With someone who’s extremely allergic, medically there’s not a lot you can do.”
Contact reporter Karissa Minn at 704-797-4222.