1. Bee Sting Allergy Blair Delaney

2. What defines “allergic” reaction?  Honey bees and Yellow Jacket wasps are a part of the group of insects known as “Hymenoptera” (Morris,2012)  Not all sting reactions are allergic – local reactions  Local reactions are confined to site of the sting  Allergic reactions are termed “anaphylactic” reactions, which are a medical emergency (Healthline,2012)  Allergic reactions occur in response to the venom of the bee sting – venom induced anaphylaxis

3. Causes of the Allergic Reaction  Systemic immune reaction – IgE mediated reaction  Occurs more commonly amongst adults than children (Healthline,2016)  Venom contains enzymes:  Bee sting enzymes: Hyaluronidase and acid phosphatase  Wasp sting enzymes: Hyaluronidase and phospholipase A1  Morris deems bee sting venom to be the more potent of the two (Morris,2012)

4. Venom Induced Anaphylaxis  According to Medical News Today, symptoms of anaphylaxis include the inset.  Signs of anaphylaxis may show immediately following being stung or alternatively they can show several hours later. (Nordqvist, MND,2013). Fig 1; “Anaphylaxis”, MND,2012)

5. Initiation of the Anaphylactic Bee Sting Reaction IgE mediated hypersensitivity immune reactions occur when the individual produces an antibody against an allergen. In this instance the bee sting. The IgE binds to the Fc receptors on the mast cells and degranulation thereof ensues. The antibody causes degranulation of body’s gate keeper mast cells releasing histamine and heparin. Histamine induces inflammatory response by causing vasodilation. Heparin thins the blood so that it can flow quicker. (Janeway et al,2001) Fig 2; “Allergic Response”, geocities.com, 1999.

6. Treatment  Administration of adrenaline in the aqueous form is the most efficient treatment for venom-induced anaphylaxis.  Often it is injected in the instance that they are experiencing a tightened/closing trachea as a result of the reaction  Intravenous fluids and glucagon are an alternative remedy if the person is on beta-blocking medication. This medication makes the individual unresponsive to adrenaline.(Paschall, 2012)  Systemic reaction sufferers must carry an auto-injection adrenaline pen as well as a written description of reaction response protocol

7. Adrenaline  Vasoconstriction- increases blood pressure and reduces swelling at site of penetration  Increases heart rate and stroke volume reversing hypotension  Relaxes muscles of respiratory system reversing respiratory difficulty

8. Diagnosis  Skin Prick Tests: These involve injecting a small amount of venom into the person and monitoring the degree of response that follows. However, there is a danger of inducing a systemic reaction.  Blood Tests: Tryptase test. Blood IgE level tests using Immunocapi208 and Immunocapi209. Coinciding with venom desensitisation immunotherapy  However, there are limitations to these tests as IgE may be tissue bound, and hence not detectable in a blood test. (Morris, 2012)

9. Reference List  Adrian Morris. (2012). Wasp and Insect Allergy. Available: http://www.allergy- clinic.co.uk/more-about-allergy/wasp-allergy/. Last accessed February 2016.  Robin Madell. (2016). Bee Sting Allergy:Symptoms of Anaphylaxis. Available: http://www.healthline.com/health/allergies/bee-sting-anaphylaxis#2. Last accessed February 2016.  Christian Nordqvist. (2013). What are Allergies? What is an Allergy?.Available: http://www.medicalnewstoday.com/articles/264419.php. Last accessed February 2016. http://www.medicalnewstoday.com/articles/264419.php. Last accessed February 2016  Velma L.Paschall. (2012). Hypenoptera Venom Allergy. Available: http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/all ergy/hymenoptera-venom-allergy/. Last accessed February 2016.