a special program of the National Emergency Medicine Association (NEMA)
Transcripts: 540.1 and 540.2
Week: 540.1 Guest: Myles Guralnick, Pres. Vespa Labs, Inc., State College, PA Topic: Bee Stings- Part One of Two Producer/Host: Steve Girard
NEMA: As I was preparing this story, my brother in law called and said he couldn't come over because he was stung by a bee, and his whole leg was swollen, and he was pretty nauseous. I knew I was on the right track....today, we're with Myles Guralnick, president of Vespa Labs in Pennsylvania...a company which develops preventative remedies for the effects of bee and insect stings.
GURALNICK: Most people are stung, in this part of the world, by yellow jackets...and yellow jacket colonies go through different phases, but essentially in the late summer, early fall, they are at maximum population, and then the nest goes into decline. And it's at this stage, which is right about now...in September, that the populations are very high, and the insects are rather aggressive...so this is the time when most people are stung.
NEMA: It always seems that the yellow jackets, going after that open soda can...or just about anything you're eating outside, are not shy about getting right in your face....
GURALNICK: Well, of all....there's lots of different kinds of wasps that sting people - yellow jackets are really sort of a wasp - there are forty or so species that will have the potential to sting people, but there's six species of yellow jackets that are the only ones that are scavengers for meats and sweets. And so, it's those particular six species of yellow jackets that are these picnic pests, and food pests that interact with us so much in the summertime.
NEMA: Many people have some severe reactions to the sting of certain bees or wasps...why is that?
GURALNICK: There's essentially several different reactions people can have. Most people have normal reactions, which are pain, swelling and redness at the site of the sting. Some people will get a large, local reaction... where all of the symptoms occur at the site of the sting, but the swelling can be very significant, in fact, you can have a whole limb swell up. But those are really not very important medically, you may require some treatment to give the patient some comfort, but they're not allergic reactions. The other type of reaction, that's serious, is the systemic reaction, which indicates allergy...and the key to understanding what these reactions are is that symptoms occur away from the site of the sting. So that, in the event that you're stung, let's say, in the hand...you may get swelling and itchiness in the face. Or you may have trouble breathing, or you may become nauseous or lightheaded. So, when you're having symptoms that are remote from the site of the sting, this is an allergic reaction and it can be quite serious.
NEMA: There was one thing you wanted to make sure was clear about seeking treatment....
GURALNICK: There was a study done some time ago that showed that a lot of people go to emergency rooms when they're stung by an insect, complaining of an allergic reaction...and that 75% of those people are just having local reaction. So, I think it would be interesting for the general public to be able to discriminate between a local reaction and a systemic allergic reaction, one that requires emergency medical treatment. That's a problem for the people...they're wasting their time and it's a problem for hospital, that they're treating a lot of people that really don't need treatment.
NEMA: We'll talk about symptomatic treatment and preventative treatment for bee stings in our next program. I'm Steve Girard.
Week: 540.2 Guest: Myles Guralnick, Pres. Vespa Labs, Inc., State College, PA Topic: Developing Immunotherapy for Bee Stings- Part Two of Two Producer/Host: Steve Girard
NEMA: This is the prime time of year for bee stings...we've been talking with entomologist and Vespa Labs president Myles Guralnick about bee sting effects on people who have allergic reactions to the venom. Yellow jackets are the main culprits...their nature, combined with their colony's reproductive cycle makes them especially aggressive. One bite can give some people excessive swelling in the area of the bite, and in worse cases, a systemic reaction including shortness of breath, nausea and lightheadedness. Myles, give me some background on how this area of research got started, at least in your company.
GURALNICK: The venom line was developed in the 70's when the founder of this company actually had anaphylactic reaction to honey bee stings himself. He was a protein chemist who was very interested in honey bee venom, and he also wanted to find a way to treat his own insect sting allergy. That is actually how the research began at this particular institution, and then it was a combination of clinical expertise, mostly by physicians at Johns Hopkins, and the founder of this company, who was a very good protein chemist, offered a lot of protein expertise. and the biology also came from him, as well as myself.
NEMA: What kinds of treatments, remedies, are available for these systemic reactions?
GURALNICK: There's really two types of treatment for insect sting allergic reactions, one of them most people are familiar with, and that's an emergency sting kit, that includes injectable epinephrine. Now, this is a form of rescue medication that's used in the event someone has a severe allergic reaction, and it can help to reverse the symptoms of such reactions. The problem with injectable epinephrine is that sometimes one injection isn't enough to reverse a bad allergic reaction. Also, people tend not to be very compliant about having it with them...sometimes they don't have it with them when they might need it. The other form of treatment, which actually treats the disease, and prevents future allergic reactions for those people that experience them, is called venom Immunotherapy, and that is a treatment involving injections of small amounts of venom - the specific venom that the patient is allergic to - which will then create an immunity, or a tolerance in that patient, so that patient no longer has bad reactions to insect stings the next time they're stung. So, one is essentially a preventive treatment so that the patient no longer has bad reactions, and the other is an emergency rescue medication.
NEMA: Is the Immunotherapy route well known at this time...or are people and doctors still checking it out?
GURALNICK: Well, there's a lot of people who use it. If an allergic patient, a patient who has a severe systemic reaction to an insect sting, is fortunate enough to go to an allergy specialist, and that patient has positive diagnosis and a positive history, that patient will be offered venom Immunotherapy. And it's extremely effective, in blind clinical trials at Johns Hopkins, it was 97% efficacious. So, the individuals that are fortunate enough to get to an allergist for this will have very good outcomes. The problem is that, particularly with managed care, a lot of patients are never referred on to a specialist. General practitioners and other primary care physicians typically do not give this sort of treatment, because it's rather complicated and specialized. So only the specialist delivers this sort of treatment and if the patient doesn't get to the specialist, he probably never learns of this treatment.
NEMA: If you've found you're allergic to bee venom...you may want to ask your doctor about venom Immunotherapy...it may be much better than treating the symptoms after you're stung. Thanks to Myles Guralnick of Vespa Labs. I'm Steve Girard.