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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?

by elityre1 min read18th Apr 20208 comments

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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

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2 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.