Bees and flowers go together like, well, bee stings and pain. While bee stings always hurt, they can affect people differently. For some, it can be life-threatening.
Dr. Rosalind Hudson and Dr. Keith Denkler authored a case report on a treatment for bee stings. (Courtesy of Dr. Keith Denkler)
“About 10% of patients with a bee — or wasp — sting sustain a ‘large local reaction’ where the swelling can enlarge to around 3 inches or more in diameter,” said Dr. Keith Denkler, a clinical professor of plastic surgery at UCSF and a plastic surgeon with a private practice in Marin.
The current treatment for noncomplicated bee sting large local reactions, he said, includes the removal of the stinger by the physician and discharging the patient with instructions to use ice packs, take oral anti-inflammatories and Benadryl, and fill a prescription for a “burst course” of Prednisone. It takes three to five days or more for the reaction to resolve, according to Denkler.
Denkler, though, has discovered — and published — a treatment called LABS (Local Anesthesia for Bee Sting) that he says eases the pain of a bee sting and shortens its duration.
His case report, entitled “Injection of Lidocaine with Epinephrine for Bee Sting Large Local Reactions,” was published in February’s Journal of the American College of Emergency Physicians Open.”
LABS “is a novel procedure that uses a small injection of local anesthetic with epinephrine to arrest the allergic reaction in a bee sting large local reaction,” he said.
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“I have successfully treated multiple consenting patients with back and extremity large local reactions to bee stings,” Denkler said. “The patient in this case report was the first facial large local reaction I had treated, and the rapid resolution of pressure, pain and swelling amazed both the patient and me.”
Last month, he applied the LABS treatment to a teenager who had stepped on a bee.
“It worked great,” he said. “I applied an ice pack, then a small local anesthetic injection with epinephrine, and she was up and about rapidly without any ill effects.”
This combination of epinephrine and local anesthetic has captured his attention over the years.
“As a young plastic surgeon, I researched and published the first study documenting that local anesthetic with epinephrine was safe to use in hand surgery,” he said. “Through the course of my career, I have used local anesthesia with epinephrine in virtually every patient who needed a procedure or surgery.”
It was when he developed a large local reaction on his own forearm after his allergist pinpricked him with an antigen that Denkler started thinking about bee stings.
“The allergist immediately put droplets of epinephrine over the puncture of the pinprick, rubbing it into the minute opening,” Denkler said. “The large hive-like reaction immediately resolved. It occurred to me that I could apply this concept to the treatment of the bee sting reaction.”
His wife, Dr. Rosalind Hudson, an internal medicine doctor with whom Denkler shares an office, encouraged him to study his theory.
In the meantime, if anyone should get a bee sting with a large local reaction, Denkler suggests to follow these steps.
• Do a self-assessment for the risk of anaphylaxis. Do you have a history of prior anaphylaxis, mast cell disease or asthma? If so, there’s a risk of anaphylaxis.
“If these patients have any current symptoms (even vague) of swelling of the lips, tongue or throat, they should either call 911 or go to the nearest emergency room,” he said. “If the patient with impending anaphylaxis has previously been prescribed an EpiPen injector or neffy epinephrine nasal spray, they should proceed (with that) treatment.”
You should not try the LABS treatment, as it’s not for anaphylaxis but rather for the delayed and large swellings called large local reactions.
• If there’s no history of anaphylaxis or the above reactions, then you should seek treatment for your local reaction either at an urgent care clinic or a physician’s office.
• “The extremely rare patient who is allergic to Lidocaine should not do this procedure, and patients who get a fast heart rate or palpitations with dental local may be better treated with the standard treatment,” he said.
Reduce yellowjackets
You can reduce the chances of getting stung by a yellowjacket by putting out yellowjacket traps in the springtime. Trapping the new queens in the 30- to 45-day window after they emerge in spring, but before they build nests, can greatly reduce their numbers.
Each queen trapped at this time represents one less nest of 500 to 5,000 yellowjackets in the summer and fall.
Show off
If you have a beautiful or interesting Marin garden or a newly designed Marin home, I’d love to know about it.
Please send an email describing either one (or both), what you love most about it and a photograph or two. I will post the best ones in upcoming columns. Your name will be published, and you must be over 18 years old and a Marin resident.
Don’t-miss events
• Learn how to maintain and sharpen garden tools when Novato Garden Club’s former president Donna Rich demonstrates the techniques following the club’s monthly meeting at 1:15 p.m. Wednesday at the Margaret Todd Senior Center at 1560 Hill Road in Novato. Admission is free. Light refreshments will be served. For more information, go to novatogardenclub.org or email [email protected].
• Need some organic young starts or plants to fill out your garden? Head to the Indian Valley Organic Farm and Garden for its spring sale from 10 a.m. to 2 p.m. May 23, 24, 30 and 31. There will be a good supply of vegetables, fruits, succulents, natives, herbs and annual and perennial flowers for sale at the on-site farm at 1800 Ignacio Blvd. in Novato. Go to www1.marin.edu/IVOFG.
PJ Bremier writes on home, garden, design, and entertaining topics every Saturday. She may be contacted at P.O. Box 412, Kentfield 94914, or at [email protected].
