Anaphylaxis and the Families of Beekeepers
Severe reactions to bee stings among beekeepers and their families is not uncommon. Among those affected are the family of Auckland beekeeper Phil Brown. Two of Brown’s three children, as well as his wife, have suffered allergic reactions. CHRIS NORTHCOTT looks into how the Browns have responded to, and reduced, the risk of anaphylaxis in several of their family members, thus allowing their beekeeping business to continue.
One day at school, the teen-aged Josiah Brown was stung by a bee on his foot while playing sports during his lunch break. Thinking little of it, he dealt with the stinger and played on.
Around twenty minutes later back in class, Josiah started to feel strange. His mind became fuzzy, his eyesight started to blur, and he was seeing unusual dots in his vision. As he went to the school nurse his face started to swell, he developed a cough, and heard cracking sounds when he swallowed. His throat was beginning to swell too. Things were heading south quickly for Josiah.
Fortunately, the school’s first aid kit included an EpiPen ready-to-go emergency adrenalin injector, which helped suppress the symptoms until he could be ambulanced to the nearby hospital.
His younger sister Annelise likewise stood on a bee and received the customary retaliation. Her symptoms were not as severe as her brother’s, but still serious enough for her to be taken to hospital as a precautionary measure.
Phil Brown, their father, is a self-employed beekeeper from west Auckland with 16 years of experience in the industry. While his two eldest kids have serious allergies to stings, their younger sibling has so far managed to avoid being stung and has not volunteered to find out what happens if he is.
Wife Rachel developed milder allergies to bee stings several years after he started out beekeeping and Brown himself suffers no adverse reactions to stings – apart of course from the usual pain!
So, in the Brown family it is only the family that is allergic to bee stings, and not the beekeeper himself.
This is not uncommon and over the years there have been several instances of New Zealand beekeeper’s children killed by bee stings and associated anaphylaxis.
According to the Auckland Hospital Immunology Clinic, someone dies in New Zealand from bee or wasp sting anaphylaxis about every two or three years. While the numbers aren’t high, it appears that beekeepers’ families are more likely to become part of that unfortunate statistic.
Research out of Switzerland in 2005 by Ulrich Muller confirmed the susceptibility of both beekeepers and their immediate family to severe sting anaphylaxis. Muller recommends three courses of action for those patients with bee venom allergies. Firstly, reduction of exposure to bees or hives is advised. Then self-medication and easy access to emergency treatment is endorsed, with adrenalin or self-injection Epipens highly recommended. Lastly, for patients with moderate to severe reactions, immunotherapy is promoted.
The Browns aren’t sure what has caused the increased risk of anaphylaxis for their family. Amongst their acquaintances there is agreement that there is a definite correlation between beekeeper’s children and severe reactions, but little certainty about why. It is thought that very minor but regular exposure to bee venom causes the body to overreact to a real dose in a sting. Muller’s findings supported that hypothesis, with the Swiss researcher determining that a major risk factor towards developing an allergic reaction to be beekeepers who had reported less than 10 stings annually.
Bee suits, or even clothes worn under bee suits, when washed with family laundry could be a source of venom transfer, but neither the Browns or any of their acquittances are sure of how their family members’ allergies have developed.
Whatever the case, his family developing severe allergies has caused Brown to change some of his beekeeping practises. He is much more cautious about allowing trailing bees to follow him or his vehicle into public spaces and takes extra effort to ensure the bees remain calm throughout a site visit to minimise stings on his suit.
He also keeps EpiPens on hand when out at his apiaries. They are a recurring expense, with most having an expiry date around 18 months after first purchase, but simpler to use than prescription vials of adrenaline and syringes. They are also an inconvenience, especially when their importance and use must regularly be explained to parents and teachers for visits to friends’ homes and for school trips. But they give peace of mind – when they are really needed, they buy time and save lives.
Rachel, Josiah, and Annelise have all had desensitization treatment to reduce the risk of an anaphylactic reaction. Desensitization is a process of carefully teaching the body to tolerate an allergen, such as bee venom, by introducing it by minute, but gradually increasing, amounts.
The goal of the treatment is to have the patient’s immune system tolerate the injected equivalent of two bee stings’ worth of venom. Interestingly, the bee venom was imported all the way from France, and it does not necessarily hurt as much as a real bee sting!
The treatment initially required multiple trips to the central Auckland hospital and Starship immunology department, but later the treatment was given at a monthly trip to their local GP. Josiah’s body had trouble tolerating some of the smaller initial doses, and so they had to delay his treatment and have the doses weakened even further to begin. But all three of them, after three to five years, have completed treatment and are now deemed at low-risk of anaphylactic reaction to bee venom.
Although they were not aware of the research carried out by Dr Muller in Europe, the Browns advice for beekeepers or families with severe bee sting allergies align with his recommendations.
“Investigate getting desensitised”, they say. At the very least it gives peace of mind, and especially for the sake of kids who are often away on school camps, out on bushwalks, or at beaches a long way from a hospital or from cell phone reception.