I was really enjoying the clean fresh look until a passenger landed on my arm and reminded me why it’s not always a good idea to leave the doors and windows open on a warm South Florida day. It was a yellow jacket, one of those bees (they’re actually in the wasp family) with the long barbed stingers off the back that none of us really like to mess with. I mentioned it to my daughter, who has spent some time working on a farm raising bees for honey and has been the recipient of lots of bee stings. She was unimpressed and told me to chill. “Anyway, Dad, don’t you know that bee stings are good for you?” Beyond knowing that it hurts to get stung by bees I had to confess that I didn’t know much about it. Anyone who knows me knows that I would never doubt anything my daughter tells me, but even so I checked into it for myself. I found out some interesting things, some which could have big safety implications for us in the air.
There are over 20,000 known bee species in the world, and 4,000 of them are native to the United States. Stinging insects are known as “Hymenoptera” (refers to the wings of the insects) and these little guys are the third largest of all insect orders—and perhaps the most beneficial to humans. The way bees actually fly was fascinating to my inner pilot self. Bees’ wings don’t go up and down in a rigid motion while they’re flying like many birds. Rather, their “mini propellers” twist and rotate to create tiny, tornado-like airflows on their leading edges (top edges of their forewings) that we all know as leading-edge vortices (LEVs). The swirls of air at the wings’ edges help the bees angle their wings more sharply toward the sky, providing lift. Except in the polar regions, they are abundant in most habitats, particularly in tropical and subtropical regions. They range from the tiny (2 mm) and solitary Perdita minima, known as the world’s smallest bee, to palm-sized species of carpenter bees. Bees are amazing and without these pollinators, humans and many other creatures would starve. Bees are responsible for pollinating at least 130 crops in North America.
But flying around inside your plane isn’t the problem; it’s when they land and what they can do to you that really count. Not all species of bees sting, and those that do are usually stinging to protect their hives or in self-defense. Bee stings can be nasty; the National Pest Management Association reports that stinging insects send more than half a million people to the emergency room every year. People with allergies to bee stings are most at risk, but anyone can be affected if a large number of stinging insects swarm and sting at once. Most people who get stung develop only local reactions that can be immediate or delayed, but occasionally patients with venom allergy develop systemic allergic reactions (such as anaphylaxis), which can be particularly severe; venom allergy is a leading cause of anaphylaxis fatalities. For most of us without severe allergies, the local reaction to bee stings is easy to control with some mild over-the-counter pain medication like Tylenol and the itch can be treated with cold compress followed up with 0.1% cortisone cream—also non-prescription at the local pharmacy. Tetanus boosters are not indicated as the sting is considered “clean” and risk of infection is extremely low. There are also several uncommon reactions that may develop after Hymenoptera stings, such as serum sickness. Serum sickness is an allergic reaction to foreign proteins that you can get from exposure to vaccines and insect stings. It can take a while to develop, sometimes up to three weeks, and symptoms include hives, swelling, fever, rash, and joint pain. Treating serum sickness involves steroids like prednisone, antihistamines, non-steroidal anti-inflammatory meds like Motrin, and obviously avoiding the source of whatever triggered the reaction.
The problem for some people is a severe allergic reaction called “anaphylaxis,” which is reported in 0.3 to 3 percent of stings, and it can be fatal. The true incidence of fatal reactions may be higher because sudden deaths occurring outdoors may be mistakenly attributed to heart attacks or strokes. Acute management of venom-induced anaphylaxis is similar to the treatment of anaphylaxis from other causes, and that’s intramuscular or intravenous epinephrine. People with these known severe allergies to bees carry “EpiPens,” with which they can inject epinephrine into their arm immediately if they get exposed again to something that brings on anaphylaxis. It can be life-threatening. Some parts of the world have higher risks of fatal bee stings that can affect up to 8 percent of some populations. Hymenoptera stings cause at least 40 identified deaths annually in the United States, and reported rates are similar in other parts of the world.
Patients suspected of having a systemic allergic reaction following a Hymenoptera sting (of any severity) should see an allergist to determine if they are candidates for something called “Venom Immunotherapy.” Venom immunotherapy (VIT) consists of a series of allergy shots that diminish sensitivity to the allergens in the venom that caused your reaction. It works; VIT reduces the risk of recurrent life-threatening reactions from 30 to 60 percent of stings to less than 5 percent by preventing future severe allergic reactions. Just carrying around injectable epinephrine is important but not enough, since it might not be handy when you most need it, and if you are unfortunate enough to have severe venom anaphylaxis, it can be resistant even to promptly administered epinephrine. So, VIT is the best preventative treatment for stings from honeybees, yellow jackets, wasps, and hornets.
Pain aside (easier said than done), my daughter was right about a few important things, and there is a bright side to this dark cloud since bee stings can actually promote health. Fifty percent of bee venom is a substance called melittin, a compound made up of 26 different amino acids. Melittin has a pretty bad rap and for good reason, since it is the stuff in a bee sting that hurts. But multiple studies have shown that melittin has a good side, since it has antiviral, antibacterial, and anticancer effects. It’s an estimate but there are about 18 to 20 naturally occurring antibiotics and antivirals in this stuff, along with anti-inflammatory substances. Bee stings can also trigger reactions in the human body that generate healing properties that would otherwise remain dormant—it does this by triggering immunological reactions just like a vaccine. There is a big recent surge in interest around medical uses of bee venom that even has a name, “Apitherapy,” and of course it has its own society, “The American Apitherapy Society.” It’s not new and has been around for thousands of years dating back to ancient Egypt and China. The Greeks and Romans also used bee venom for medicinal purposes to treat joint pain from arthritis. More recently, studies have shown that bees can treat multiple sclerosis and immune system disorders that attack the skin and nerves. If you are still looking for that “Fountain of Youth” that I talked about last month, try bee venom—a recent study published by the NIH found that beekeepers live longer, healthier lives than the rest of us!
If you’ve never been stung by a bee, you don’t know if you might be allergic to the venom. Be careful; the number of people with true life-threatening allergies is small, but if you are unfortunate to be someone who does have a venom allergy, it can be extremely dangerous to you and anyone else in your plane if you had the windows open and let one of those guys ride along. But if you do get stung by a bee, chill out, put some ice on it, and take comfort that you might live a little longer. Watch out for those bees and fly safe!
