Bee Stings and Emergency Mangement.

Introduction.

A few weeks ago, I was beekeeping at an out-apiary with my friend Alison when she reacted badly to a bee sting about 15-20 minutes after the event. Fortunately the outcome was good but it was a very frightening experience. We want to share it with you so Alison has written a guest blog which will follow on next week. Meanwhile, Dr Richard Bache which will set the scene.

Richard Bache MBBS BMedSci MRCGP NDB has kept bees for over 20 years. He is a BBKA Master Beekeeper and in 2021 he received the National Diploma in Beekeeping. Richard is a medical doctor and works as a General Practitioner Partner in his native Somerset, England.

He is very knowledgeable and passionate about nature and wildlife, especially insects. Richard has the largest collection of beekeeping books of anyone that I know and is interested in every aspect of beekeeping. However, teaching lies closest to his heart.

Richard and I have been friends for a couple of since joining the same small online study group. When I asked Richard if he would write something on bee stings and management, I explained that Beelistener relies on donations and that I could only afford to pay him in Ecclefechan tarts which I would send south. He happily agreed but said that he could come up and collect them in person. So, the other day Richard brought his wife Iris and 3 small daughters to visit from Aviemore where they are holidaying. We had a great visit with a picnic lunch in the garden and visits to the observation hive and wild bee tree.

Bee Stings.

Non-beekeepers can be forgiven for not knowing everything there is to know about bees, but the two things they are most likely to know are that bees make honey and they sting. The later point is to some extent unavoidable, despite the declarations of old bee sages that “ahh, they don’t sting”. Bee stings in apiaries are much like Charles Dicken’s accidents: they “will occur in the best-regulated families […], they may be expected with confidence, and must be borne with philosophy”. Although they are almost inevitable, they are certainly not all unavoidable and a mark of good husbandry is to take steps to reduce the nuisance they cause and know what to do when bees do sting. Thankfully most bee stings are just a brief source of pain and a resultant expletive before the beekeeper moves on. But bee stings can cause serious problems and death. Only a handful of people will die each year in the UK as a result of bee stings, but it is it principally an overwhelming allergic response called anaphylaxis that causes these deaths. There are a few other bee sting reactions that are similarly serious. Stings can precipitant asthma attacks and heart attacks in rare instances. Bee stings to the eye ball need specialist input and stings in the throat can cause swelling where it is critically dangerous. There are a few things the beekeeper should do the manage this low risk.

Prevention.

Like accidents, prevention of bee stings is the best course of action. Bees do not sting with equal frequency and the beekeeper should aim to keep those bees that are less likely to sting. Colonies where you repeatedly receive stings or those that follow should be black-marked. For some this will be a case of eliminating the queen and requeening the colony from more favourable stock, but for those that are an immediate risk the use of petrol to kill the colony is a course of action that needs to be considered. Such unpleasant colonies should not be tolerated or ignored as the longer they persist the more the risk that they replicate their undesirable traits and spoil the temperament of future generations of bees in the vicinity. Each beekeeper should be prepared to eliminate the most defensive colonies each year and those with the skills and the stock should raise queens and aim to improve or maintain the best tempered of their bees.

Defensive Traits in Honey Bees.

Defensive traits in the honeybee are not entirely determined by genetics though. A lot can be learnt from observing and following the example of an expert bee handler, where movements are careful and purposeful, smoke is used appropriately and care is taken to avoid squashing bees or jarring the hive. Other traits of bees may be relevant here and handling can be more difficult if there is a lot of propolis, for example. Having said that, well-made bee hives with well-maintained bee spaces around all movable parts help a lot. Other environmental factors will be at play and queenless colonies are usually more problematic, large colonies need more skill to handle and those suffering from robbing are often much more defensive. Any other disturbance will also increase defensive behaviour in bees and one of the most defensive colonies that I have ever encountered was one twenty years ago which had a rare visitation from a death’s head hawkmoth (Acherontia atropos). The moth had not survived the bee’s fury at this unwelcome visitor and I certainly felt it also! The weather will also influence honeybee temperament and bees should ideally be manipulated on fair-weather days, not least of all because a significant proportion of the bees that can sting will be away from the hive foraging. Sometimes it is not clear why bees are more defensive on one particular day, but if these factors cannot be controlled, improving the stock through queen replacement needs to be considered. Bees ought to be kept where they are not likely to be a inadvertent nuisance, away from regular visitors and public rights of way.

Reducing Risks.

The risk of being stung is also a determined by the protective clothing the beekeeper wears. Many a careless sting has been received from a casual peek under the crown board or to check a feeder without a veil and we have all seen that lazy worker stumble out of the cleared supers you are lifting and give you grief while your hands are occupied. There are many photos of beekeepers without veils, usually with a tiny colony and often used as a statement about the docility of the bees, but this is often an unnecessary bee sting risk. On the other hand, it is easy to forget to fully zip up a bee suit or bring a bee back to the car inside a crease of clothing. Wrists and ankles are frequent gaps that allow bees to get trapped next to your skin and agitated and this can be minimised with gauntlets or long gloves, and boots respectively. Care can reduce these risks, as well as well-made and well-maintained clothing.

But bees still sting from time to time and some people will suffer as a result. It is worth knowing in advance whether visitors to the apiary have been stung before and whether they know they react badly. It would be inadvisable for someone with severe and untreated allergy to visit bees. This is also true if they suffer increasing reactions, especially breathing issues or light-headed symptoms, both of which can indicate a severe systemic reaction.

Getting Assistance.

Think about what would happen if someone really needed help. It is worth being prepared about what to say after the questions about whether the victim is conscious and breathing, you will need to state that there has been a bee sting reaction. How would you describe your apiary to the 999-call handler? Postcodes are helpful in built up areas, but might be less helpful in more rural or remote areas where a description of the location using road names or local landmarks may be more useful. Some more obscure areas may require someone to ‘flag down’ the ambulance.  These things are often forgotten in the heat of the moment and for the regularly visited apiary having some succinct location details on a laminated sheet in a prominent place would be sensible. Typically risk assessment will consider both the likelihood and consequences of risk and while the individual risk of serious bee sting reactions is low, for larger events some dedicated policy and qualified first aid provision should be considered.

Being Prepared.

There is also an onus on those who know they react badly to bee stings to be prepared as a bee can sting anyone at any time. Those who have suffered a severe reaction should be prescribed two Adrenaline autoinjectors such as an EpiPen, Jext or Emerade. This should be carried with them, stored appropriately and replaced when expired. The recipient of an adrenaline autoinjector, their family and first aiders should be familiar with their use. For those keen to know, instructions can be found on the relevant manufacturer websites and links are on the NHS website, Anaphylaxis – Treatment – NHS (www.nhs.uk) .

For those who have suffered a severe bee sting reaction, or a moderate reaction with ongoing risk of further exposure, desensitisation therapy is an option that should be discussed with your doctor. It involves repeated administration of increasing amounts of the bee sting allergen over many weeks so that your immune system adapts to moderate its response and does not cause an overwhelming response. It is often done through immunology clinics and therefore repeated travel may be expected, but it is proven to be an effective therapy for those at risk.

What is a Bad Reaction?

So, what constitutes a bad bee sting reaction? All bee stings have mediators of inflammation and will cause some local swelling, pain and redness. Sometimes this swelling might be impressive, especially around the eyes, and sometimes large parts of a limb might be swollen. However, these are all ‘contained’, local reactions that look alarming and might be jolly uncomfortable, but are not particularly worrying. Serious reactions often involve a more systemic immunological response to specific allergens within the venom and while they may present in different ways, a drop in blood pressure (causing light-headedness) or breathing difficulties are both worrying symptoms that should not be ignored. Anaphylaxis, one of the more common serious bee sting reactions, progresses quickly and may also present with wheezing, a fast heart rate, clamminess, anxiety and confusion or collapse.

Reducing Effect of Bee Stings.

There are a few key things that will reduce the effects of bee stings:

1. Safety: Ensure that the area is safe. This may involve getting someone vulnerable away from the bees or closing a particularly feisty hive if they are unmanageable.
2. Remove the stings. The amount of venom for a sting is largely related to how long it stays in, so to reduce the effects remove it quickly. The method of removal does not seem to be important. Sting pheromone, iso-pentyl acetate, acts as an alarm pheromone also, so will provide a ‘marker’ for further stings.

For most people this will be all that is required. However, in addition to the above, for serious bee sting reactions:

• Call emergency services (999 in the UK) or those who are showing signs of a serious bee sting reaction, especially if they have breathing symptoms or light-headedness.
• If they are known to suffer from severe reactions and carry an adrenaline auto-injector such as an EpiPen, this ought to be administered. This may be repeated after 5 minutes if their symptoms are not improving.
• Loosen any tight clothing, especially around the neck. The patient should sit down or, better still, lie down with their legs raised, to aid circulation. Unconscious patients should be placed in the recovery position.

Thankfully, serious bee sting reactions remain rare, but good beekeeping practice can make them rarer and careful management of the stung individual can reduce the risk of the most serious complications.

Thank You.

Thank you, Richard, for this well written and reassuring blog which I am certain the readers will find very useful too. I look forward to more good advice on dealing with other other beekeeper situations and reducing the risk of accidents in the future.