By Alice Fabbre, Special to the Tribune
July 10, 2013
The warmer weather brings out the bugs and flying insects — and some of them bite and sting. But how do you know if you need to take a Benadryl, rush to the emergency room or just put some ice on the sting or bite? We talked to Dr. David Zich, a physician with Northwestern Medicine, for advice on how to handle bee stings, mosquito bites and ticks. Here's an edited version of our interview:
Q: Assuming you aren't allergic to bee stings, what's the best way to treat a basic bee sting?
A: The first thing you need to do is to get the stinger removed if it's still in the skin. Grabbing it with your fingers is fine. The most important thing is that it comes out quickly, as soon as possible.
After that, get out of the area. When a bee is in danger and when it stings it releases what is called alarm pheromones. This release is greater if the bee dies. If there is a hive or a swarm nearby then it will attract other bees that behave in an aggressive manner.
Then put cool compresses on the area (of the sting). You can wash it with cool water and soap. It also might be of some help to apply either a topical anesthetic that is over-the-counter, a Benadryl cream or a steroid cream. But it is not critical that you do any of these because it will heal on its own. Usually the pain goes away within a few hours, but the itching and swelling can last for a week.
Q: What if you didn't think you were allergic, but now all of a sudden you've been stung by a bee and it appears you are having an allergic reaction. What's the best course of action? What are the typical warning signs that you are allergic?
A: In general you cannot be allergic to a bee the first time you're stung. You have to develop an allergy and about 2 percent will develop a sensitivity to the sting after being stung one or two times. About a half a percent will develop a severe allergy.
We divide the two allergies between local and systemic. Local reactions occur at the site or area of the sting, whereas systemic reactions involve the entire body.
Local reactions can be mild, from a little bit more swelling than usual, to severe, where the entire hand or limb swells up after the sting. The systemic reactions are the ones that are life-threatening, where you can have difficulty breathing or your blood pressure can drop drastically.
Initially they are all treated the same way — you have to remove the stinger immediately. Cold compresses can limit the spread of the venom initially. And then if you are having signs of an allergic reaction, the most important thing is to get to the emergency department. With people who have had previous allergic reactions, if they have an EpiPen they should use it (if there are) signs of a systemic reaction. You can take Benadryl, 50 mg, if you have it available, but you should not delay getting to the emergency department for a systemic reaction just to find the Benadryl. If you just have local swelling, it is not critical to go to the emergency department. Cool compresses and Benadryl should be sufficient.
Q: What's our best protection from West Nile virus and mosquito bites?
A: Common sense is stay indoors during peak mosquito hours, which are dusk and dawn. Wear insect repellent when outdoors and eliminate sources of standing water, which include buckets, pans, old tires, and those are where the mosquito that carry West Nile breed.
Q: Are there any special tricks to take away the itch from mosquito bites?
A: There are many different home remedies, none of which are particularly effective because the chemical that causes the itch is below the skin and the home remedies don't penetrate the skin very well. The things that may work a little bit are Benadryl cream or a high- or extra-strength hydrocortisone cream.
Q: How can you tell if you've been bitten by a spider, and is there anything you should be careful of if you have been bitten?
A: This is one of my favorite topics because so many people come to the emergency department and say, "I've been bitten by a spider," and so many studies done show that the majority of people who say they have been bitten by a spider (actually have) something else.
There are over 500 species of spiders in Illinois. Some do bite, but the only ones that are of any danger are the brown recluse and the northern black widow. These are very rare, especially in the Chicago area. Both spiders are not aggressive. They tend to run instead of bite, and therefore, actual bites from these spiders are extremely unusual.
The brown recluse bite may continue to expand and get worse. If that happens, being evaluated by your doctor is a reasonable thing to do. Black widow spiders do inject a venom that can cause systemic symptoms including muscle spasms, nausea, vomiting and abdominal pain but are rarely life-threatening. If you have these symptoms, being evaluated by a doctor is prudent. However, most of the time there is nothing to do but treat the symptoms. Under severe circumstances, there is a black widow anti-venom but I personally have never used it or seen it used in my 17 years as a doctor.
Q: You've been out in the woods, and you discover a tick. What do you?
A: Remove the tick; the best way to do this is to grasp it with tweezers at the base and try to make sure that the entire tick is removed. Put it on something sticky like a piece of tape, and I recommend keeping it. The reason is, not all ticks transmit illness, and if you start developing signs of illness, then having the tick to identify is very important. If it has not been on for a long period of time — Lyme disease requires at least 24 hours of attachment — there's nothing else to do.
However, if you suspect it has been on for more than 24 hours then you should see your doctor because the Illinois Department of Public Health does recommend prophylactic treatment for Lyme disease in certain circumstances.
There are other illnesses that ticks can transmit that are rarer in Illinois, but (we see some of them) because we are in the Chicago area and a lot of people go to Wisconsin and northern Michigan. What people need to do then is simply be aware that if they develop a fever that lasts more than five days with muscle aches or joint pains, they need to go to their doctor and make them aware that they have been bitten by a tick.
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