1. A tale of stings and reactions Dr Jon Tuppen Sproughton

2. Alfred Dürer, 1514: Eros, Venus and the bees "Eros stung by a bee, when he inhaled the pleasant fragrance of a rose, went crying to take refuge in the arms of Venus," Dear mother, I die, have mercy on me, a flying snake bit me painfully cheek " Anacreontic singing, 6th c. av. AD "

3. What is this? Melittin – 26 amino acid peptide

4. Is this an allergic response?

5. Bee Venom: Composition, Health, Medicine: A Review Stefan Bogdanov http://www.bee-hexagon.net/files/file/fileE/Health/VenomBookReview.pdf

6. Sting components all designed to break down normal permeability

7. The recognition system- seek and destroy

8. ....then things get a bit complicated

9. Anaphylaxis – what is it? Acute onset of an illness (minutes to several hours) with involvement of the skin, mucosal tissue, or both (e.g., generalized hives, pruritus or flushing, swollen lips/tongue/uvula) Respiratory compromise (e.g., dyspnoea, wheeze– bronchospasm, stridor, reduced PEF [peak expiratory flow], hypoxemia) Reduced BP (blood pressure) or associated symptoms of end-organ dysfunction (e.g., hypotonia [collapse], syncope, incontinence) Persistent gastrointestinal symptoms (e.g., crampy abdominal pain, vomiting) Sense of Impending doom

10. Clinical features of systemic reactions to bee or wasp stings Bee (11)Wasp (43) Generalised pruritus624 Urticaria624 Angioedema526 Laryngeal oedema511 } Asthma420 } 72% Gastrointestinal615 Visual disturbances3 7 } Hypotension without LOC516 } 88% Loss of consciousness315 } Ewan 1984

12. UK cases of fatal anaphylaxis

13. Where are people most likely to get stung? n=278

14. How to recognise anaphylaxis

17. Anaphylaxis – what to do if it happens. Shout for Help!! Don’t take chances – phone 999 – remove sting If the person has medication – give it- –Antistamines –Steroids Use Adrenalin auto-injector sooner rather than later i-m in outer thigh –Repeat x 1 after 5mins if no improvement Get patient to hospital for observation

18. How to give i-m Adrenalin

19. Thank You