Recognizing And Treating Insect Bites And Stings In Athletes

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With bee stings, extensive local reactions in patients may cause severe pain, prolonged edema and intense erythema. Stings may also cause moderate reactions that may include malaise, nausea, vomiting and wheezing.
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Author(s): 
By Mark A. Caselli, DPM

Stinging insects and ticks can cause problems for athletes who participate in outdoor sports or activities. At the very least, these stings or bites can lead to itchy and irritating skin conditions. On the more extreme end, these stings or bites may lead to serious anaphylactic reactions or Lyme disease. Therefore, it is important for sports medicine practitioners to recognize the potential conditions and dangers that may come from these insect bites and stings, and know how to institute appropriate treatment.
Stinging insects belong to the order Hymenoptera, which includes bees, wasps and stinging ants, just to name a few. Hymenoptera stings reportedly cause anywhere from 40 to 150 deaths a year in the United States, with the vast majority of the deaths due to anaphylactic reactions. Approximately one in every 200 people is dangerously allergic to Hymenoptera venom.
Those who participate in sports and other outdoor athletic activities are especially vulnerable to Hymenoptera stings. Yellow jackets and honeybees are often drawn to sports drink refreshment coolers, which athletes count on to stay hydrated during games. Yellow jackets and fire ants (which are especially problematic in the southern United States) can also sting athletes on practice fields.

Key Treatment Recommendations
For Varying Reactions To Bee Stings
When a nonallergic athlete suffers a Hymenoptera sting, he or she may present with moderate to severe pain, a localized wheal, erythema, pruritis and edema. The honeybee has a barbed stinger and leaves its stinger and venom sac in the wound. (Other insects in this group do not have barbed stingers and may sting multiple times.) Since the honeybee leaves its barbed stinger imbedded in the skin, the first step in treatment is removing the stinger. One should scrape away the stinger with a fingernail, the edge of a credit card or a knife (if available). Do not use forceps or tweezers. If you grasp or handle the venom sac, it will compress and inject additional venom into the skin, causing a more severe sting.

In some patients, more extensive local reactions may result and include severe pain, prolonged edema and intense erythema. These symptoms can last up to a week and may progress to infection and cellulitis. Insect stings can also result in systemic allergic reactions that range from mild to severe. Moderate reactions may include malaise, nausea, vomiting and wheezing. The most severe systemic reaction is anaphylaxis, resulting in hypotension, bronchospasm and laryngeal edema.
Use cool compresses or ice for localized stings in nonallergic athletes. You would treat localized reactions in allergic patients the same way but administer antihistamines as well to reduce the inflammatory component of the reaction. In delayed local reactions that appear after 24 hours, one should consider a five-day course of prednisone.
In the case of a severe allergic reaction, one should promptly administer subcutaneous injections of aqueous epinephrine 1:1000 in a dosage of 0.3 to 0.5 ml. You can repeat this injection in 20-minute intervals for a total of three injections. Ensure that the victim is in a supine position with his or her legs elevated. Contact emergency medical services as soon as possible. Aggressive resuscitation of the patient may be necessary in the event of respiratory or cardiac arrest.
From a proactive standpoint, it is a good idea for coaches and team physicians to ask athletes if they have had severe reactions to insect stings so they can take the appropriate precautions.

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