[Focus On Training] Anaphylaxis: A First-Hand Account

Editor’s note: The following article was submitted to PCT by Randy Ault, a pest control service technician at Clark Pest Control, Sacramento, Calif. Ault recently suffered wasp stings and had an anaphylactic reaction. As a result, he researched and then presented a safety briefing for other Clark technicians. The following article has been adapted from his presentation.

Who is allergic to nuts? Who is allergic to bee or wasp stings? I’ve been doing pest control for more than 10 years and I’ve heard the simplified safety briefings that "some people are allergic to bee and wasp stings." But they never tell you what the symptoms are or how serious that reaction might be.

I’ve been stung several times over the years. Being stung hurts at the location of the sting for a little while, then, as the poison is absorbed, the pain subsides and pretty soon, goes away completely.

However, last autumn I was stung by two or three wasps and this time the symptoms didn’t go away. My first symptoms appeared within an hour of being stung and these symptoms progressed throughout the afternoon. My armpits itched, then the palms of my hands started to itch too. I saw in the mirror that I was flushed. I knew I was reacting to the stings. Still, I went ahead with my route work.

I quit work early that Friday and went home, not feeling "right" but not feeling bad enough to go to the doctor or hospital either. When I got home (six hours after being stung) and changed out of my uniform, I noticed that my crotch and thighs were bright red.

I went to the "Healthwise Handbook" that Kaiser Permanente sends to its members and looked up the section for insect stings and bites. I then found out (and later had my doctor confirm) that I was suffering from anaphylaxis.

Anaphylaxis, or anaphylactic shock, is a severe allergic reaction that occurs rapidly and causes a life-threatening response involving the whole body. These reactions can occur within seconds to minutes of exposure. Occasionally, they are delayed. You may develop sensitivity and anaphylaxis to a substance that you have been exposed to many times in the past without a reaction.

SYMPTOMS. Symptoms of anaphylaxis usually occur within seconds to minutes of exposure to the offending allergen and range from mild to severe. These symptoms include:

• Rapid pulse, sweating, dizziness, fainting, unconsciousness

• Wheezing, chest tightness, difficulty breathing, coughing

• Itchy hives, which may blend together to form larger areas of skin swelling

• Swelling of the lips, tongue or eyes

• Nausea, vomiting, abdominal cramps, diarrhea

• Paleness, bluish skin color

• Throat swelling, with a feeling of throat tightness, a lump in the throat, hoarseness or obstructed airflow

Other symptoms include:

Skin: Most anaphylactic reactions will involve the skin. Hives, welts or wheals (raised bumps), and generalized erythema (redness) may appear. Look for swelling in the face, eyelids, lips, tongue, throat, hands and feet. Hives can cause severe itching.

Breathing: Swelling narrows the airways. The person may have difficulty breathing, resulting in wheezing and chest tightness. Upper airway involvement causes hoarseness, coughing, nasal congestion and sneezing.

Cardiovascular: A person experiencing anaphylaxis may exhibit a rapid heart rate, low blood pressure, shock, dizziness and loss of consciousness.

General: Someone experiencing an anaphylactic reaction may experience difficulty swallowing, nausea, vomiting, diarrhea, abdominal cramping and bloating, anxiety, weakness and confusion.

Death: Airway obstruction and cardiovascular collapse (shock) are the leading causes of death from anaphylaxis.

TREATMENT. True anaphylaxis is a medical emergency and requires treatment in a hospital’s emergency department.

People with a history of anaphylaxis should wear a medical identification bracelet or necklace to alert others in the event of a severe reaction. In addition, ask your doctor if you should carry a prescribed, pre-loaded syringe of epinephrine. At the first sign of symptoms, you or a competent helper would inject the pre-loaded epinephrine to treat your allergic reaction temporarily until you reach medical attention. (See related story on page 70.)

Inject yourself with a premeasured, prescription dose of epinephrine. Known as EpiPen or Ana-Kit, these self-administered medications are easily and rapidly injected into the thigh muscle. This is extremely effective and fast acting. Anyone who has experienced a prior anaphylactic reaction should carry these kits. (Note: Even though you administer epinephrine to yourself, this does not mean you don’t have to go to an emergency room or doctor immediately. Anyone suffering from a severe allergic reaction should be seen by a physician as soon as possible, with or without self-treatment with epinephrine.)

With appropriate treatment, mild cases of anaphylaxis usually resolve within a few hours. If untreated, anaphylaxis can cause death within minutes to hours.

It is impossible to predict how severe the allergic reaction will be. Any person who shows signs of anaphylaxis will require treatment in a hospital’s emergency department where the condition can be monitored and life-saving treatment can be given. If swelling develops rapidly, particularly involving the mouth or throat, and you have trouble breathing, feel dizzy, lightheaded, or faint, call 911 for ambulance transportation to the hospital.

While awaiting the ambulance, administer your EpiPen.

PROGNOSIS. With prompt, appropriate treatment, most patients who have suffered severe allergic reaction can recover completely. Unfortunately, even with treatment, some people die from anaphylaxis. A person who has had an anaphylactic reaction remains at risk of future severe reactions if he or she is exposed again to the same offending allergen.

The next time I’m stung by a bee or wasp, I’m going to seek emergency medical attention immediately. I’ve got kids and grandkids that I want to enjoy as they grow. I’m not going to call the office to tell my manager. I’m either going to the nearest emergency room, or, if I recognize the severe symptoms, I’m going to dial 911, request an ambulance and say, "Hi. My name is Randy. I’ve just been stung by a wasp and I’m having an anaphylactic reaction. I’ve taken my EpiPen shot and I’m sitting in the Clark Pest Control truck at 1 Heaven’s Gate in West Sacramento."

You can see that anaphylaxis is a serious reaction to a bee or wasp sting. It can kill you so don’t ignore the symptoms.

Editor’s note: Anaphylaxis is a serious medical condition that your doctor must diagnose. The information here is not a substitute for a visit with your physician. The EpiPen is a prescribed medication.

The author can be reached at rault@pctonline.com.