Deaths from stings can be detected, prevented with testing, treatment

Published 12:00 am Thursday, August 26, 2021

By Aerik Williams and Caitlyn Cross

On Aug. 8, a 36-year-old man in China Grove sadly passed away from what was most likely a severe allergic reaction to an insect sting.

He represents a small percentage of our population (0.3-3%) sensitized to insect venom. His death is devastating and unfortunate. However, it’s a reminder that venom reactions are preventable with medical therapy.

Venom is a toxin that hymenoptera such as the yellow jacket, wasp, honey bee and hornet excrete when they sting. While most people will experience only local pain and redness at the site of the sting, those that are allergic may experience a severe reaction. In the simplest of terms, venom-allergic people have created antibodies that recognize insect venom as a harmful substance. Following exposure to insect venom, these antibodies stimulate an immune reaction that can lead to hives, difficulty breathing, swelling, nausea, diarrhea and/or low blood pressure. Together, these symptoms are termed anaphylaxis.

Approximately 50 people per year in the United States will die from venom sting-induced anaphylaxis.

For individuals who have reacted to insect venom, a blood test or a skin test can be performed to determine the presence of allergic antibodies. The presence of these antibodies confirms the diagnosis of venom hypersensitivity. The American Academy of Allergy, Asthma and Immunology recommends that all venom-allergic patients be considered for venom immunotherapy (VIT), an efficacious and safe prophylactic treatment designed to prevent anaphylaxis following insect sting. Though counterintuitive, VIT exposes an insect sting allergic person to very small doses of venom via subcutaneous injections once weekly for 15 weeks. The dose of venom exposure increases in small intervals each week, allowing the recipient to safely reach a state of tolerance. In order for the effect to be maintained, a monthly injection for five years is required. Though cumbersome, studies have demonstrated that venom allergic people who choose prophylactic VIT reduce their risk of anaphylaxis following sting from 50% to 2%.

In addition to prophylactic therapy, all people with venom hypersensitivity should have access to epinephrine via an autoinjector. Epinephrine is synonymous to adrenaline and its effect counteracts the symptoms of anaphylaxis almost immediately. Hence, epinephrine is life-saving in the setting of anaphylaxis. Epinephrine auto-injectors can be prescribed by any medical practitioner.

Deaths from venom-induced anaphylaxis are preventable considering the efficacy of VIT and epinephrine. If you have a history of venom sting reactions, it is imperative that you discuss this history with your medical provider.

Dr. Aerik Williams is a physician at Allergy Partners of Rowan-Salisbury, which is an asthma and allergy practice. Caitlyn Cross is a fourth-year medical student at Campbell University School of Medicine. Their article is in reference to a 36-year-old man who died after being stung while mowing a lawn in the China Grove area. 

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