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1 June 1999 | Volume 130 Issue 11 | Page 943
We thank Drs. DeGrandi-Hoffman and Hoffman for pointing out the differences between a honeybee and a yellowjacket. Given this explanation, this patient probably had an allergic reaction to a yellowjacket. However, acute to subacute treatment in the emergency department would not have changed our management.
Dr. Levine recommends subcutaneous administration of epinephrine followed by intramuscular administration of diphenhydramine. It is agreed that for acute anaphylaxis, subcutaneous epinephrine and antihistamines, such as diphenhydramine, should be immediately administered. However, we did not administer these treatments because our patient had no evidence of hypotension, shortness of breath, pruritis, or uticaria and was closely observed in the emergency department.
It is true that steroids are commonly used for these types of reactions. Although steroids are not effective in preventing the relapse of anaphylaxis symptoms 6 to 10 hours after therapy has begun, they may have both anti-inflammatory and antichemotactic effects and may diminish the likelihood of a rebound effect or a biphasic response. Biphasic reactions, which may occur in as many as 20% of patients, are noted 6 to 10 hours after the resolution of signs or symptoms (a few patients have episodes lasting as long as 24 to 48 hours). Thus, we administered a short course of steroids, which resolved our patient's dysphagia.
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Bee Sting Dysphagia
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Northwestern University Medical School; Evanston, IL 60201 (Shah)
Northwestern University Medical School; Evanston, IL 60201 (Tsang)
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  H.C. G. Wong Importance of Proper Identification of Stinging Insects Ann Intern Med, March 7, 2000; 132(5): 418 - 418. [Full Text] [PDF]
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