Anyone here hyper-allergic to bug bites? Any treatment issues?

[Nords]

Spouse (46 years old and not happy with the aging process) had a bad week with her allergy to insect bites. Over the last couple decades, one bite or bee sting at a time, she's developed a progressively worse sensitivity. She's never been anaphylactic-- yet-- but now she's being threatened with daily doses of Allegra (fexofenadine).

Five days ago she did some light yardwork & exterior painting and thought she was getting sick--tickly feeling in the back of her throat and an achy head. The next morning she was hard down: aches, fever, chills, dizziness, sore throat, hoarseness. The third morning she woke herself up scratching at a group of 23 (!) small bites inside her left bicep. She realized that she wasn't "sick" but was having an allergic reaction. She treated this with 3*20mg of prednisone and one Allegra per day for 3 days. It usually works pretty quickly, and within two hours her symptoms improved. Even if it's a placebo effect it's a good one.

On day four she relapsed to a sore throat & chest congestion so she doubled the Allegra dose. She recovered and did fine on the fifth day too, so we spent it watching the bites fade away. (Whaddya do all day indeed.) They were probably from an ant or a flea.

This morning (the sixth day) she was even worse-- more chest congestion, sore throat, hoarse, coughing, and feeling weak in her neck/arms/hands. (Oddly enough the bite site was the best-looking part of her-- fully recovered.) I'm not prone to panic but she looked scary enough to go straight to the clinic. More prednisone & Allegra. She's all better again-- so far.

Assuming she doesn't upgrade herself to a weekend ambulance trip, she's going back to the clinic on Monday morning and she'll probably get a consult with an allergy specialist. That typically takes 30 days.

This week was unusual because she didn't realize she'd been bitten, and so whatever was injected into her bites had a couple days to work on her. (Her bicep looked like she'd been bruised by shotgun pellets in a two-inch group.) She's had hot, itchy bite sites before but she's never been this sick. This time the prednisone & Allegra doses didn't seem to be lasting long enough, either.

For some reason she's a bee magnet-- a dozen stings over the last decade. In the past after a bee sting she'd get a gluteal Benedryl shot and follow up with her prednisone and Allegra for three days. All better. Or she'd get 3-5 ant bites and would self-medicate, again, a three-day course of prednisone and Allegra. Again all better. 23 bites is a personal record. In the past she's asked about an epinephrine injector (the "Epi-Pen") but the doctor said it wasn't necessary.

Another complication is that she runs on low blood pressure. Her BP is "normally" about 100/60, but it droops when she gets a bite reaction. Today at the clinic she turned in a 90/55, which caused some fuss before they checked her record. But we don't know if her low blood pressure contributes to the bite reaction.

The doctor couldn't identify her bug bites (we couldn't either) so we'll have to check out Al's photos again. I should point out that not only have I been bite-free this week, but in her company I'm rarely ever bitten. (I love this woman!) I'm supposed to be the one who's allergic to dust mites but I've been fine. I don't think we're dealing with bedbugs because we have anti-dust-mite mattress/pillow covers and fresh bed linens. If she'd been stung by a scorpion, centipede, or bee there would've been immediate "recognition". She was working in an area that typically has a lot of ant traffic (small, black, sugar-seeking) but no biting red ants. Oahu doesn't have fire ants or chiggers, unless REWahoo has some personal news that he wishes to share with the rest of the board.

Is anyone else dealing with a venom sensitivity like this, and how? Is anyone on a daily Allegra, and is it causing any problems? Does Allegra (or antihistamines in general) have any side effects on BP? Any other treatment ideas?

 

[W2R]

Maybe a little, but nowhere near as severely as your wife!

In 1970 my thigh swelled to over double its normal circumference due to a bee sting (plus I felt faint). That really scared me so I have been extremely cautious since, and haven't been stung by a bee since. I freeze and make it loudly known to everyone nearby that "I am allergic to bees, get me out of here!!!" if I see a bee.

In 1980 I was stung by a yellow jacket, though. It scared me to death, because I thought the sensitivity might carry over but it didn't. Normal response. Ow.

In 1984 I moved to Texas and was immediately stung by hundreds of fire ants while at an outing at a lake. Seriously, I counted over 300 bites. Each fire ant bite swelled up like a boil. After that I avoided fire ants, but in Texas that was nearly impossible to do with 100% efficiency. When I was stung, even by a few, I got boil-like reactions that other people didn't seem to get. I also got some pretty shocking reactions to spider bites in Texas. After moving to Louisiana, I have not had any fire ant or spider bites.

I guess my strategy has been to actively avoid bites - - the longer I avoid them, the more my sensitivity seems to decline. No doctors, no Allegra, and so on. Moving to different parts of the country more often than I might like, has helped since the bugs are different in different states.

 

[KB]

My son has a bee allergy which we found when he was about 7. He was stung and his foot swelled excessively. I was told to treat him with liquid Benedryl as soon as possible and watch for excessive swelling or breathing problems. He never had those symptoms and had to go to the ER, fortunately.

As he got older and camped with the Boy scouts, he carried an Epi-pen when they went backpacking where he couldn't get medical care within a reasonable time frame.
I still have the Epi-pen....I bet it expired years ago...

 

[lazygood4nothinbum]

only had bug problems as a kid. even mosquito bites. i'd get a bad reaction if the bite was on my face, but not anywhere else. and the closer to my eyes, the more the bite swelled. that stopped as i got older.

but i just want to comment on allergists really. i've used them twice to great success. the first time i had shots as a kid because allergies used to put me in bed for weeks at a time. after shots, no problems for about 30 plus years. then in my 40s i got hit by allergies again. five more years of shots and now my allergic reactions, while not completely gone, have been reduced by 90 plus percent.

 

[Moemg]

I've seen several anaphylactic reactions and the situation goes out of control quickly . She really should see an Allergist . You don't want to mess around with any allergy that is getting worse especially that tickly feeling in her throat .

 

[Martha]

Man, I am with Moemg. She might need to start carrying an Epi-pen. I have to carry one. I have to do the prednisone thing a couple times a year.

It is also possible that the 23 "bites" on her bicep are not bites. Sometimes its hard to tell allergic rashes from bites.

 

[Sarah in SC]

I've only had one bad reaction, to a hornet. The site was huge, like Want2 described. I had to get on steroids and antihistamines like everyone else. I have an expired epi-pen, but that's about it.
I'm with the other folks, Nords, she needs to be evaluated by an allergist as it sure seems to be escalating. This would be an excellent way to get out of doing yard work at your house!

 

[Nords]

This would be an excellent way to get out of doing yard work at your house!

Oh, thanks a lot!

Speaking as our house's [-]laborer for management[/-] backup yard guy, and as my spouse logs on to check the threads, mere words can't express my reaction to your sentiment...

 

[Sue]

I get huge welts from misquitoes and black fly bites that last from 7 to 10 days. Taking antihistamines has never relieved the symptons of these bites. I've found if I immediately treat a bite with a product called "After Bite" or a steriod cream prescribed by my doctor, I rarely get a severe reaction.

The best defense is to avoid being bitten. I wear clothes treated with permethrin and eat raw garlic when I am going to be outside for extended periods and these bugs are around. If you mix the raw garlic with hummus, it's easy to eat and reduces the number of bites to almost zero. Interestingly, no one has ever complained about any garlic ordor.

 

[Moemg]

The real thing to worry about is her throat swelling and not being able to breathe . Most of the severe allergic reactions I've seen always started with my throat feels tingly or I feel weird and that's when you'd better have an epipen . An oral medication will not be quick enough in a severe reaction .

 

[tangomonster]

Nords, have we convinced your wife to at least carry an Epi pen?

 

[Nords]

A week now since the original bites and her second doctor's visit this morning. He agrees that she reacted badly to whatever bit her and that her breathing passages are probably still inflamed.

No Benadryl shot but more prednisone & Allegra. She was told that if she takes the prednisone for longer than three days then she has to tail it off instead of stopping cold turkey. Apparently that's not so much a withdrawal symptom as it is an adjustment that her body might not tolerate well without gradually flushing out the steroid.

She's going to consult with an allergist, and with this trend it'll probably get her an Epi-Pen. She's asked for one before but I think the breathing issues will probably tip the scale this time. She has plenty of prednisone & Allegra refills, too, so she'll be able to build up a stash.

 

[MichaelB]

Nords, after resolving the treatment aspects your wife should look into insect repellents. For bees I'm nost sure what's out there besides deet.

Our adult daughter developed severe reactions to fleas, mosquitos, spiders, and ants, and now reacts with severe swelling wherever bit (altho no breathng passage issues yet ). and still getting worse every bite. Now her closest constant companions and best friends are cutter deet and cortisone cream. In this case an ounce of prevention is worth a whole lot more than all the cures out there.

 

[Nords]

Nords, after resolving the treatment aspects your wife should look into insect repellents.

She figured that out in the early years of our marriage and she never goes outside without repellent & sunscreen. Judging from this bite they're either not totally effective, or they're the only thing that's kept her alive so far.

Two weeks since the first batch of bites, and she's mostly recovered. One more day of prednisone and she's done with that. She's waiting on the allergist consult. She's still coughing but she sounds better-- upgraded from "lung heave" to merely "yikes".

Her cough will probably go away on its own but I think she's designing a medication double-blind trial involving Delsym & Bailey's. Or maybe "double" refers to the size of the dose...

 

[Cantuar]

Does she usually get fever and chills with allergic reactions? One of our friends seems to be allergic to just about everything, and we've been hearing about her symptoms (from hives and rashes to anaphylactic shock) in excruciating detail for years, but I've never heard her mention fever.

The reason I'm wondering is that I gather that viral infections can sometimes really exacerbate allergic reactions. I sometimes get hives after exposure to shellfish but they only last a few hours; however, one time it happened when I was just getting over a really bad cold or something, and they hives and rash went on for a couple of weeks. A couple of friends of ours who were quite used to being around our dog ended up in the emergency room with allergic reactions after being around her when they had or were just recovering from a viral infection.

So I'm wondering if your wife was battling some sort of virus at the time she was exposed to the insect bites and that caused the reaction to be worse than usual. If that's the case, she might not get a reaction like this every time she has a run-in with an insect in the future. Not that I'm suggesting that she refuses the Epi-Pen if it's offered, though.

 

[Nords]

Does she usually get fever and chills with allergic reactions?

Nope, just progressively worse symptoms of bite reactions. Over 20+ years and a dozen or so memorable bites, each episode is worse than the last. She's been told that eventually she's going to hit anaphylactic-shock territory. She already tries to stay away from bees (as much as possible in a tropical climate).

So I'm wondering if your wife was battling some sort of virus at the time she was exposed to the insect bites and that caused the reaction to be worse than usual. If that's the case, she might not get a reaction like this every time she has a run-in with an insect in the future.

Don't know about the virus; she didn't have any virus symptoms before the bite. We get most of our viruses from our kid's high school so it's possible. But virus or not, the reaction to each bite has been steadily worse.

I've been stung by bees & wasps and bitten by centipedes, but none of my reactions even make it to her Richter scale. There doesn't seem to be any preventive therapy like desensitization infusions, either. It looks like the medical community is counting on prompt treatment, fast ambulances, and (eventually) a declining immune response.

 

[Meadbh]

Nords, DW should see an allergist and get an EpiPen. Her symptoms sound like mild anaphylaxis. Severe anaphylaxis can completely occlude one's airway and may be fatal without prompt treatment. (sorry to be so blunt).

She should also be thankful that she was not in New Brunswick this morning:

globeandmail.com: New Brunswick town abuzz as millions of bees set loose

 

[spideyrdpd]

You can buy medrol or prednisone in a taper package (prescription)
My guess would be that the dose she took was too low.
I would also switch to either zyrtec or chlotrimeton when the symptoms are that bad. benadryl would actually work best but its the most sedating. They now have the medications that disolve under the tongue which may be worth carrying for emergencies.

Rob

 

[Nords]

Nords, DW should see an allergist and get an EpiPen. Her symptoms sound like mild anaphylaxis. Severe anaphylaxis can completely occlude one's airway and may be fatal without prompt treatment. (sorry to be so blunt).

I re-read my allergist comment and I realize now that it's ambiguous-- she's waiting on the allergist consult because the clinic has forwarded the TRICARE request and she's waiting for them to set up an appointment. She should be there in the next couple weeks.

The last allergist consult (a year ago? two?) didn't get her an Epi-Pen because her symptoms weren't severe enough. This throat/cough issue is brand-new and will probably merit the appropriate attention.

 

[Meadbh]

she's waiting on the allergist consult because the clinic has forwarded the TRICARE request and she's waiting for them to set up an appointment. She should be there in the next couple weeks.

I thought we Canadians were the only people who had wait times......!

 

[windsurf]

I thought we Canadians were the only people who had wait times......!

Here in Ohio there is a typical new patient wait for specialists like allergists and especially dermatologists (months). I had occasionally been stung by yellow jackets (vespids) through life without anything more than the usual pain. Then, about 15 years ago, I was stung by 5 or 6 and had a mild reaction: elevated heart rate, flushed skin. One year later, I was stung and went anaphalactic–very unpleasant! by the time got to ER, I was feeling better but had major swelling in the stung leg. One week later, my daughter saw me running across the lawn from the mower and had the epi pen that had just been prescribed in her hand. Wham in the thigh with the fat auto needle–the stuff works! Haven't had to use one since and I have gone through about 8 years of once a month immunotherapy venom shots but always still tested positive though I was told I had some degree of desensitization. I decided to stop the shots earlier this year. I try to remember to have the epi pen with me but don't always. The "danger" time seems to be mid-summer through early fall. The buggers seem to get more aggressive in th elate summer. After the first frost until the following summer, they aren't an issue around here. I'm hoping that the shots have conferred some benefit. The physician was very vague about where I stand and would have me taking the shots forever. I have read some studies that range from saying that five years is the advisable limit for the shots to others saying there "may" be a benefit to continue. I wonder how much mercury preservative I've absorbed from all the shots.

 

[Rich_by_the_Bay]

Nor rare, but I once had a patient who drank a yellow jacket that had gotten into a can of soda at a picnic. It stung her on the roof of her mouth. She required an emergency intubation.

Be careful out there.

 

[windsurf]

Nor rare, but I once had a patient who drank a yellow jacket that had gotten into a can of soda at a picnic. It stung her on the roof of her mouth. She required an emergency intubation.

Be careful out there.

That's excellent cautionary advice. I use a piece of napkin or something to stop the opening when my can or bottle (beer) is sitting. I imagine that a sting in the mouth or throat would be excruciating even without anaphalaxis. As you say the swelling could create a med emergency.

 

[Khan]

Nor rare, but I once had a patient who drank a yellow jacket that had gotten into a can of soda at a picnic. It stung her on the roof of her mouth. She required an emergency intubation.

Be careful out there.

Back in the '60s, my sister got stung on the lip by a yellow jacket in a soda can. It wasn't pleasant, but fortunately for her there was no allergic reaction.

 

[W2R]

One more reason not to drink soda!! Who wants it, anyway. It is too sweet and fizzy for me to drink very often.