Do you know how to prevent getting insect stings and bites? How do you know if you are having an allergic reaction? Watch as one of our Nurse Educators, Ann Mullen, RN, talks about the signs and symptoms of an insect sting allergy, explains steps you can take to prevent getting stung, shows how to use an epinephrine device for severe allergies and answers other FAQs.
Alyssa Paschke: Hello, everyone, and welcome to our July Q&A. Since it's summertime, everyone's spending a lot of time outdoors doing fun activities and that increases the chance of you getting an insect sting or bite. Most reactions to these stings or bites are pretty mild, and you can treat them pretty easily at home. However, some people will experience an allergic reaction to an insect sting or bite. Some of these reactions can become severe or even life-threatening. More than 1 million Americans, each year, say they experienced an allergic reaction to an insect sting, and 50 people die each year.
Alyssa Paschke: Today, we are speaking with Anne Mullen, who is a registered nurse here at National Jewish Health, and she teaches patient education classes. She's going to tell us about the different ways you can prevent insect stings and bites, and how you can treat them at home. For the severe allergic reactions, we're going to go through the signs and symptoms of that and demonstrate how to use two epinephrine devices, one, the EpiPen, and one, the AUVI-Q. That's going to treat the severe allergic reaction called anaphylaxis. As we go along, if you have any questions, feel free to type them into the comments section, and we'll get to as many as possible.
Alyssa Paschke: Thanks for speaking with us today, Anne. Could you begin by talking about the different types of insects that sting or bite this time of year and what are the symptoms you can experience?
Ann Mullen: Some of the insects, you think of honeybees as being a common insect that would sting, but they’re other stinging insects, so wasps, hornets, paper wasps and fire ants are probably common insects that will sting.
Alyssa Paschke: Gotcha. Then, if you get stung from one of those insects, what are some of the typical symptoms you would experience.
Ann Mullen: If you don't have an allergy, you may get a red or white raised area. If it's white, it may be red around it, it may be painful, it may itch.
Alyssa Paschke: Gotcha. For those common stings and bites, if you don't have the allergy, what do you recommend is kind of the at-home treatment-
Ann Mullen: Treatment.
Alyssa Paschke: ... that you can do?
Ann Mullen: You can look at the area and see is there a stinger there. If there is, you want to take out the stinger either with your fingernails or tweezers, but not all, say a honeybee, will leave a stinger. Other wasps potentially could, but they may not. Try and take out the stinger. Put a cold compress on it. That can help relieve some of the pain and the itching. You can take some pain reliever like aspirin or ibuprofen. That can be helpful. Those are the common things you would do.
Alyssa Paschke: Does that vary depending on the type of insect that stung you like a fire ant versus a bee, for example?
Ann Mullen: I would be pretty similar if it's just this basic local reaction and you don't have an allergy.
Alyssa Paschke: Great. Well, that seems simple enough. What symptoms would you look for in a friend or family member or yourself if you are experiencing an allergic reaction?
Ann Mullen: An allergic reaction would go beyond just this local reaction. If you're bitten on your arm or stung on your arm, it may go beyond your arm. It may be a bigger local reaction. You may have hives, trouble breathing, wheezing.
Alyssa Paschke: Really just kind of watching to see if the symptoms move beyond just the initial stings or bite-
Ann Mullen: Right.
Alyssa Paschke: ... that you're getting?
Ann Mullen: Right.
Alyssa Paschke: When does the reaction become severe that you would recommend someone seeking medical attention?
Ann Mullen: If it goes beyond the local reaction, so it's affecting other parts of the body, especially if it's affecting your breathing, swelling of the mouth; that's when you really want to.
Alyssa Paschke: Great. Would you recommend people call 911 or just kind of visit an urgent care?
Ann Mullen: If they have a severe reaction, so we call this a severe anaphylaxis reaction, if it goes beyond, they have trouble breathing, especially that; then we want to treat it with epinephrine injection and then go to the emergency room.
Alyssa Paschke: Gotcha. What is anaphylaxis? Can you describe that a little bit more?
Ann Mullen: Anaphylaxis is a severe allergic reaction that is life-threatening. A person, if they have an anaphylactic reaction, they've usually had some exposure before that, so maybe you've been stung by a bee and you had a local reaction, but now your body sees this as foreign and you can develop an allergic response to it, so then you can potentially have an anaphylactic reaction.
Alyssa Paschke: Gotcha. You might not have an anaphylaxis reaction for the first exposure but maybe subsequently.
Ann Mullen: Later you may.
Alyssa Paschke: That's good to know. For someone experiencing anaphylaxis, we want to demonstrate a couple devices out there. One is the EpiPen and the other is the AUVI-Q. If you could just walk us through kind of the differences in the devices. I know they look different, I know they are accomplishing the same goal of delivering a medicine, so if you want to just kind of walk through the device and how you would use it.
Ann Mullen: There are a number of devices out there and I'll just demonstrate two, but there are a number of epinephrine auto-injection devices that you can get. One that I'll demonstrate is the EpiPen. Another one is AUVI-Q. These are both trainers, so there isn't medication in these. When you purchase one of these devices, you usually get two medications, but you also get a trainer, so you can practice this with the trainer to make sure you have correct technique.
Alyssa Paschke: Oh, great.
Ann Mullen: With any device, you're going to give the injection in the outer thigh. If it's a young child, you want to hold their leg down so they don't move. With EpiPen, you take off the top, you have a positioned like this with your thumb at this end, the medicine's going to come out of the orange end.
Alyssa Paschke: Gotcha.
Ann Mullen: Then, you press it against your outer thigh and you hear a click. You press and then when the click happens, the medication's going in, so I count to three, one, two, three. Then, take it away and this orange area covers up the needle.
Alyssa Paschke: The needle. Gotcha.
Ann Mullen: That's using the EpiPen. Then, you call 911, have somebody take you to the emergency room because this only lasts about 20 minutes and then you're back where you were, so you need to go to the emergency room. Bring the device with you, so they can dispose of it.
Alyssa Paschke: Gotcha. That's typically why there's two in a package, right, so just in case you're not getting to the emergency room as fast as the medication works, you can do it again. Correct?
Ann Mullen: Right. Right. If it's not helping in 15 minutes, you can do another one on your way there.
Alyssa Paschke: Gotcha. Well, that's great. Then, now, the AUVI-Q device.
Ann Mullen: This device talks to you, it tells you what you need to do. You pull off ... Well, I'll tell you first. You pull off the outer case and then it will start talking. I'll pull the red piece off, put it on my outer thigh and count. Let's go through it. Take off the outer case.
AUVI-Q Trainer: This trainer contains no needle or drug. If you are ready to use, pull off red safety guard. If to inject, place black end against outer thigh. Then, press firmly and hold in five, four, three, two, one. Injection complete.
Ann Mullen: This walks you through step by step what you should do. Both of them also have pictures, so you can look and see what do you need to do, what's step one, step two, step three. Then, call 911 with either one. With the AUVI-Q, it had me hold this for five seconds, counting five down. They've changed the guideline and it's kept holding it for two seconds, so when I hold it, I say, "Two, one." Most of the medicine is done in that first second with either device.
Alyssa Paschke: Well, that's great. I want to take a moment since you've demoed those to see if any questions have come in from the audience about that.
Speaker 4: Wondering if Benadryl is helpful when you get stung.
Ann Mullen: You want to be in a ... If you get stung and you're having a severe reaction, we'll have you use the EpiPen because we don't want you to not use enough medicine and then the reaction is still happening. If somebody has a large local reaction, one of the things they may do is use an anti-histamine. Generally, it's nice to use an anti-histamine that's non-sedating.
Speaker 4: Then the other question is, are the auto-injectors available. Do you need a prescription for them, are they available at most pharmacies or how do you get them if you're concerned?
Ann Mullen: That's a good question. You need a prescription from a physician or advanced practice provider for any epinephrine injections.
Alyssa Paschke: Gotcha. Then, you would just ... Would you need a diagnosis of anaphylaxis in order to get the prescription? Typically, with the provider, do you just kind of say you're concerned or do you need a diagnosis of something?
Ann Mullen: Often people will have talked with their primary care provider. Depending on the situation, they may go to an allergist who really goes through a thorough history to see what is the allergy, especially if there's an anaphylactic reaction or potential anaphylactic reaction. Then, they'll write the prescription.
Alyssa Paschke: Great. Any other questions? All right. I was wondering along the lines of diagnosing an insect allergy, I know here at National Jewish Health, we have the ability to do that. Could you walk us through how you actually would receive a diagnosis of an insect allergy?
Ann Mullen: When we see a patient, the healthcare provider, physician or advanced care provider will go through a thorough history with the patient when they had the reaction, where were they, did they see any insects, did they see the insect that stung them or other insects in the area to get an idea of what type of insect they may have an allergy to. We can do allergy skin tests. There are panel of insects that are likely to cause allergies that we can do skin testing to. Then, that helps us determine what the allergy is to.
Alyssa Paschke: Great. Then, when you would have that diagnosis, is there anything that you can do to prevent insect stings if you know you're allergic but you still want to be able to participate in outdoor activities?
Ann Mullen: There are a number of things you can do. First of all, avoiding areas where there obvious bees, hornets, things like that. You want to avoid those areas as much as you can. You want to wear light-colored clothing, not as much dark colors or colorful shirts because the insect may think you are a flower and they can come and sting you. You don't want to wear perfumes or colognes. If you're sweaty, wiping off the sweat so you don't smell as much. All of those things can be helpful. The other thing is instead of going barefoot, wearing either close toes shoe, or flip flops are okay, but still, the insect can sting you. Those are some of the preventative things you can do.
Alyssa Paschke: Then, as far as, I know there's a lot of like insect repellent sprays and those sorts of things. Do you find that those are also effective?
Ann Mullen: They may be also, but these are the first primary things we have people do.
Alyssa Paschke: Protective clothing, protective shoes, no colognes and perfumes, that totally makes sense.
Ann Mullen: Another thing that we can do for treatment, if somebody is, let's say they have a job outside and so they're probably going to be exposed, they've had anaphylactic reactions to some insect; we can do allergy shots or immunotherapy for that insect. That's another thing that we consider in addition to all the preventive measures once we'd done the skin testing. That's a helpful way if you see an allergist to find out what are you allergic to and what are all the things we can do.
Alyssa Paschke: Gotcha. I guess the allergy shots, does that ... I know maybe it depends on the allergy, but how long would that therapy typically take or is it kind of dependent on the person?
Ann Mullen: We can take different timeframes to get you ... we increased the dose in the allergy shot and then get you to a maintenance level where you have regular allergy shots, maintenance shots.
Alyssa Paschke: Gotcha.
Ann Mullen: But, it can be varying times to get to that point.
Alyssa Paschke: Well, that is a good option out there for anybody, like you said, that has frequent exposure outside and also has anaphylaxis. I wanted to pause more time to see if any other questions have come in.
Speaker 4: Yeah. Cindy asks if the allergy to insect stings continue to get worse each time you get stung.
Ann Mullen: It's hard to predict how severe a reaction will be. You really need to be ready all the time. After you've had that first exposure, it could be anaphylaxis or it could be a large local reaction, so it's important for everybody to have an action plan, so they know if I do get stung, I've got my epinephrine here, I can give that, go to the emergency room, I know what to do.
Alyssa Paschke: Gotcha. I have a question to follow up on that. Once you get to the emergency room, is that why you recommend bringing the device so that they know you've taken that medication and I guess kind of along with that, that you do have anaphylactic reactions?
Ann Mullen: Well, they can help dispose of it, so that's one thing they can do. They can look at it and see, did you get all the medication, they can see if the device is expired. They can check a number of things that way.
Alyssa Paschke: Great. Any other questions? All right. Well, I think we're coming up on our time here and I wanted to thank you so much, Anne, for being with us today. I hope everybody out there in the audience has a great and safe rest of their summer, has more knowledge about insect stings and bites, and that you can save a life by using an epinephrine device like the EpiPen or the AUVI-Q. If we didn't get to your question or if you ask a question after we're done with our live broadcast here, we'll respond directly to you in the comments on this video. Feel free to like this video and share it with friends and family. If you have or need any more information from National Jewish Health, you can visit our website at www.njhealth.org. Thank you.
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