Bee Stings: Lifesaving Information with Dr. Juanita Mora, MD

0:00 in a world brimming with complexity few creatures embody harmony like the honeybee with tireless precision she dances from bloom to bloom each motion guided by millennia upon millennia of instinct each act in service to the whole and then There are the beekeepers, watchful stewards of this ancient symbiosis. Part agriscientist, part poet, they move along their hives with the efficiency of mow, levy and curly, tending to the bees' needs as best they can comprehend, and with the infrequency of a waterfall in the Sahara, sometimes running off flapping and flailing like a penguin on a hot sidewalk. This is their journey. Welcome, welcome to Be Love Beekeeping presented by our good friends over at Man Lake.

1:27 Today's expert guest is a board certified allergy doctor and allergist. We will be discussing everything about bee sting allergic reactions and what you can do to save a life. This may be the most important beekeeping podcast you have ever listened to. Be sure to share it with your beekeeper friends. But before we go to our discussion with Dr. Mora, let's take just a couple of minutes. for some interesting facts about bee stings and bee venom. Number one, bee venom is mostly one protein. About 50 % of bee venom's dry weight is melaton, the peptide responsible for most of the pain and tissue damage from a sting. It's actually one of the most studied venom peptides in biology.

2:16 Two, only female bees can sting. The stinger is a modified, oh I hope I can pronounce this correctly, ovipositor or egg -laying organ. So drones, which are all boys, have no stinger and can't sting at all. Number three, worker bees die after stinging but queens don't. A worker's barbed stinger lodges in mammal skin and rips out part of her abdomen when she pulls away. But queen bees have smoother stingers without the barbs. These are designed for fighting rival queens, not for defense of the hive, so they can sting repeatedly and survive. However, there are some exceptions if a worker bee stings something with thick or leathery type skin. like another insect or thick clothing. Rather than mammal skin, the barbs may not catch, letting the bee escape and sting again. Number four, the stinger keeps pumping venom after detachment. Once a worker bee stings and the stinger tears off, muscles attached to the venom sac keep contracting for a few minutes, pumping in more venom even though the bee itself is gone. That's why beekeepers know the best thing to do is to scrape a stinger out quickly rather than pinch it. Number five, venom triggers an attack me alarm pheromone.

3:47 Isopental acetate, a component released alongside the sting, smells a little like bananas and signals other bees to join the attack on the same target, which is part of why beekeepers avoid eating bananas near their hives. Number six, bee venom is used as a real medical treatment. Purified bee venom is used in allergen immunotherapy shots to help people build tolerance and reduce the risk of severe allergic reactions to future stings. Number seven, melaton is being studied for medicinal uses beyond just allergies. Researchers have investigated melaton's potential effects on bacteria, viruses and even cancer cells in lab studies.

4:37 Though it's still an active area of research, there aren't any approved applied treatments quite yet. And lastly, number eight, temperature and bee mood can affect the venom yield and therefore affect the sting itself. Bees can produce different yields depending on colony health, season, and stress levels. So if you've ever had a much bigger reaction and more pain from one sting versus another, there really is actually a reason for it. It can be a real thing. I'd like to welcome our very special guest today. We have Dr. Juanita Mora coming to us from, is it Chicago? Chicago.

5:22 Chicago, and she's an allergist and oh my goodness, a wealth of information. I've been looking forward to this a long time. How are you, Dr. Mora? Oh, so wonderful to be with you and on this wonderful podcast to help educate our public, which is always one of my big passions. Allergies come up all the time in beekeeping, well in talk about beekeeping. And one of the things as a beekeeper that non beekeepers ask us the most is, do you ever get stung? And oh, I could never do that because I'm allergic. So first of all, yes, we get stung and it's okay. We don't really care. But let's, where should we even start talking about bee venom allergies? Where should we jump in? Well, maybe how many people suffer in the United States? So we know in the United States, when we're talking people allergic to V -Venom, we're talking about 2 million Americans. And out of these 2 million Americans, we know that 20 % of all anaphylaxis or severe allergic reactions happen in people who aren't allergic to V -Venom.

6:30 It accounts for 45 ,000 to 50 ,000 hospitalizations, emergency department visits every single year. and we lose 72 people secondary to fatal or mortal bee sting allergy every single year, which is why it's so important that we talk, especially with people who work with bees and are beekeepers year -round. I have so many questions. I'm going to try to I'm going to try not to get ahead of myself too far And so where I want to start is let's talk about bee venom allergies because some people have different kinds of reactions localized reactions Some people have a reaction that is not localized For example, they get stung on their thumb and they get hives on their back And then other people have a real anaphylactic reaction. Can you take those three things and let's put the proper terminology to what we're talking about. Absolutely. So when a person comes in to be evaluated for a bee sting or any insect sting. First thing, you know, taking the histories.

7:37 So a lot of people get what's called a large local reaction right where they get this thing. They get an actual big hive that occurs right at the area. And sometimes it extends in the arm, but that's where it stays. It doesn't go into full body hives. There's no throat swelling. There's no eye swelling or anything. Then basically there's people who have a non -localized reaction like you described where they might get stung on their wrist and then they develop hives on their legs or different things. But again, just one localized area. When it becomes anaphylaxis is where we're looking at two or more systems involved or anything like threatening. Two or more systems involved might be breaking out in hives and lip swelling. Breaking out in hives and eye swelling. Breaking out in hives and vomiting.

8:26 Or anything life threatening. Feeling like your throat is closing. Swelling obviously of the tongue that can actually occur as well too. Shortness of breath or wheezing or dizziness and feeling like you're about to pass out. It's called anaphylaxis and at that point we need epinephrine. Okay. How does somebody know when they need epinephrine and to rush to the hospital and when they don't? You know, you mentioned two different reactions, but expound on that a little bit. Sure, so what I teach my patients all the time is when two or more systems are involved or anything life -threatening You're gonna want epinephrine epinephrine first and ready and the reason for it is I tell them it's better to be safe rather than sorry You won't hurt anyone by giving them epinephrine.

9:16 It's basically adrenaline and help stops an allergic reaction in seconds to minutes And what you're looking for is a fast response, because a lot of people sometimes are scared to do an epinephrine device. And they're like, well, maybe I'll just take a little Benadryl. Maybe I'll just take a little Zyrtec. It'll pass. But you don't want to take the risk when it's an anaphylactic reaction. So any symptom that's life threatening, throat closing, shortness of breath, wheezing, feeling like you're about to faint. or two or more systems involve skin and eyes, skin and GI, so vomiting, skin and lungs, any two combinations or one life -threatening, you're going to give epinephrine right away and call 911 to make sure the allergic reaction has completely stopped and is resolved.

10:04 So even if you get epinephrine and we're talking an EpiPen or a nephi, anytime that you give that Does that mean you need a trip to the hospital or a 911 call or is that enough for some people? Sometimes it's enough, but when it's a first time reaction, you want to make sure to call 911 when it's someone who maybe has had an allergic reaction before and they're using the epinephrine and they know when their symptoms are resolved, then they might be more at ease with, you know, calling their doctor, and then being monitored by their doctor via phone and making sure the allergic reaction has completely stopped. We always carry our epinephrine devices, whether it's Nephi or an EpiPen, in a two -pack. And the reason for it is because if within five minutes we do not get resolution of symptoms, you use the second actual device. So if the first nephi is not completely resolving the symptoms, then you're going to use the second nephi into the nostril and go ahead and repeat the dose. Same with the nepinephrine pen as well, too, to make sure the allergic reaction is resolving. All right. Let's talk a little bit more about bee allergies. One of the things that I've read multiple times, and tell me if you know anything about this, is that beekeepers who do not have any kind of an allergic reaction to bee venom can develop that later in life or whenever. How does

11:37 that work and why does that happen? Well, when we have looked at studies that have looked at beekeepers, what would account for desensitization in terms of stakes. So if a bee stinging me, how many stings do I have to get in a year for me to be desensitized to be like, oh, I'm not going to react at all. 200 bee stings will keep you desensitized, desensitized and tolerant. But most beekeepers do not get 200 bee stings they got. So most beekeepers get about 25 bee stings, but 25 bee stings actually do not create a desensitization. They can create a sensitization.

12:19 So at one point or another, our bodies can decide that they are allergic to B -venom when they've never been allergic before. It's that one thing that suddenly comes, changes our immune system and can occur. And what basically then puts anyone at risk who is a beekeeper for anaphylaxis. When we look at rate of anaphylaxis in beekeeper, it ranges from 15 to 47 % in beekeepers depending on probably how big their hive is, how many stings they get a year, et cetera. When I hear things like that, my recommendation on our podcast is, and always has been, every beekeeper should have some kind of epinephrine, whether it's an auto injector, EpiPen's the one we've all heard of, Nephi, which I know you're very familiar with and we'll talk more specifically about the difference in a few minutes. Everybody should have one because as a beekeeper, oh I'm not allergic, I can develop an allergic reaction. Also, I have Kids that come around and want to see the bees. I have grandkids that want to be involved. I have neighbors.

13:34 Some people teach classes. Some people do agritourism things where people come in and they have a beekeeping experience. Especially if you're doing a lot of that. Please just be safe. Cover yourself legally and just be safe and be prepared for something like this. Have it on hand and know how to use it. Amen to that. Amen to that. I couldn't agree more. Every beekeeper should have epinephrine on hand for themselves and also for any little visitors as well too. So in both doses, the pediatric dose and the adult dose as well too. So that way we make sure that everyone is covered. We don't know when an allergic reaction can occur and we want to make sure that we save lives. We know that we lose 72 people a year to bee sting allergy. and anaphylaxis, so we want to make sure that we save as many legs as possible. Yeah, that's just way too many when there is something that we can do about it. Another thing along those lines that I've read a lot about is that families of beekeepers, even if they're not involved in the bees, have a higher percentage of them end up developing some kind of allergic reactions. Are you familiar with that? Yes, and part of the reason why that occurs is because even though they're not the primary beekeeper They're still in contact with the bees and they go in and get the honey, etc So it puts

15:04 them at higher risk. They might be lower risk for as many stings as the beekeeper But they're still at risk which might actually put them That's why they're at rest for anaphylaxis because they're still have exposure to the honeybee venom Yeah and it can even be on your clothes of a beekeeper. Like your beekeeping jacket and veil. Some bees will be trying to sting you from the outside. That then may come into the house to be put in with the laundry or something. And my understanding is even if you're not being stung that is a type of exposure to some of that bee venom. Are those things correct that I've been reading? You are correct, 100 % correct when it comes to that.

15:51 Yes, we don't have to be exactly stung, but yes, we can also be exposed through just contact as well. If someone does not have one of these devices already, something of epinephrine, do we have to go to our doctor and get a prescription? And if we don't have an allergy, is our doctor going to give us a prescription? Well, I think just by vocation of being a beekeeper. I think most doctors would definitely write for an epinephrine device being an EpiPen or an Nefi device as well, too. Quick break to discuss what just might be on your mind right now. Come on, admit it. You're imagining the upcoming honey harvest. Because no matter where you live in the world, it's either here now or it will be in the near future. And Man Lake is making it so easy to plan for. Click on over to Man Lake's website for an amazing selection of extractors, filters, bottling supplies, uncapping knives, supplies for comb honey, everything.

16:53 And I mean. everything you'll need. But if you aren't there quite yet and the honey flows right around the corner, make sure you have extra supers on hand. You never can have too many or be too prepared. And right now Man Lake is offering podcast listeners $10 off your next order. Just enter code MLBLove10 at checkout. That's manlakeltd .com. Discount code MLBLove10. Nephi has a program though on their website that if you for example want to get access to a Nephi you can actually go on Nephi .com and be connected with a doctor there who will be able to write your prescription as well too if needed for both the pediatric and adult dose given that you're a beekeeper as well too. Give us an idea of what they cost and how often we have to replace them because I know they don't last forever. No, so when we're talking Epi pens Epi pens are basically one -year usual shelf like and you have to check the date because sometimes They take them right off the shelf and they might be expiring soon. So that I always tell people check the date You're looking at a cost depending on what state you live in probably like $300 when it comes for a two -pack and most people require Two two packs, right?

18:17 So that way you're gonna have an adult and a child dosage as well, too. When we're talking nephi, it's basically a shelf life of two and a half to three years. Right now, the company has negotiated. So even if it's commercial actual pay insurance, then it's one hundred and ninety nine dollars max for a two pack for the nephi. What I like about nephi as well, too, is one, it's ease of administration. Right. So you just go right into the nostril. Because as an allergist and immunologist, I have found that a lot of people with the nephrine injection, they are afraid of the needle. So they hesitate upon giving it to themselves or to others. And that's really scary because it's seconds or minutes that are worth gold, right? You need to act fast. And so Nephi, I have found, makes a lot of my patients less anxious and have more relief. The other thing I like is the temperature also that extremes of temperature that it can have. With EpiPen, one of the things that they have to watch out is for the temperature extremes because you can't leave it in a hot car because then it won't work or in freezing temperatures. With Nephi, it goes up to 145 degrees Fahrenheit that it can reach and then the lower portion it can actually freeze and if you thaw it within 20 minutes should beautifully still work. So just so people know kind of the

19:49 differences between both. As soon as Nuffy came out, I'll tell the story. I had all these moms with college students who have food allergies going, Dr. Mora, you gotta write the Nuffy for my kid because there's no way my kid's gonna carry a big EpiPen to the bar where there's peanuts right on the table. And I wrote so many at that point, but I realized what they were saying. They wanted a little bit of peace for themselves and peace for their child, but yet be well protected with the device that they could use. And I found you through the Nephi people and I do not, we need to be careful. This is not an infomercial today. Okay. We're talking about safety for everybody.

20:31 And I don't care which device you pick, just have it on hand. know how to use it. To me, again, personally, not an advertisement, Nephi makes sense because you don't have a needle. Okay, let's talk about this. How do you use an EpiPen or one of the other auto injector brands? So one of the things is when we use an EpiPen, and I actually have a demo here, I'm in the office. Are you going to actually stab yourself and do it right now? That was so well, this is an actual just it doesn't have any real medication or real needle So it's just a practice demo So the way I always taught people to use it is you would grab it in a nice fist because you don't want to poke your fingers with it Blue to the sky orange to the thigh. It doesn't matter if people are wearing jeans or anything They're wearing you take the blue cap off and then you're going to stab right at the thigh I'm gonna pretend this is my thigh You're gonna stab and hold for three seconds a thousand one a thousand two a thousand three and then it's got a needle guard So you don't poke your fingers with it as it comes out So I had a lot of parents who at that point are really nervous So instead they did it upside down and they poke their fingers and turn them blue. No No, no Yes, I've had a lot of incidences like that Okay. And this is real

22:01 life. So this is why I tell these stories. So obviously this is I practice with every parent or every patient in this in the exam rooms, because I want to make sure that they're able to use it. And now I'll show you the nephew and a beekeeper who just has this on hand, probably hasn't practiced, maybe didn't get this little training from their doctor. So I appreciate you filling that in. OK, show us the nephew. How does it work? So the nephi is in the same type of device that narcanis So people will be more familiar with it because it's obviously what it is It's you're gonna press an actual tab right in the middle They're gonna go right into the nostril and they basically just have them relax there. I usually have people count to five So a thousand one a thousand two a thousand three a thousand four a thousand five And then it completely starts acting. I've used both of them on kids and adults, and I know they work really, really fast. And obviously in a life -threatening event, you're going to want to use one of these devices immediately.

23:09 So with the nasal spray, the Neffe, do they have to like, you know, breathe in, sniff in hard or anything like that? No, that's the beauty of it that you don't have to it just starts acting completely. It goes in right into the sinuses, goes right into the actual throat, goes to the lungs, into the bloodstream, into the rest of the organs, the heart, the lungs, the brain, etc. So that way it starts completely shutting down the allergic reaction. which is exactly what we want. Intramuscular does the same thing, but it just acts through the muscle, goes into the bloodstream, et cetera, to hit the other organs. And whoever you jab it in may punch you in the face when you do it. What is epinephrine?

23:55 Tell us a little bit more about it. Epinephrine is basically adrenaline. And since you have a fun podcast, I always tell this story for patients luck. we're talking about epinephrine and adrenaline as it shuts down to receptors that cause allergic reactions. I said you're not supposed to use it like in Pulp Fiction where they put it right through the heart. I said for the epipen to the muscle for the nephi to the nose and I said it just within seconds to minutes starts completely acting. at the alpha and beta receptors. So these are your adrenergic receptors in your cells that start shutting down the cascade and the allergic actual reaction that can occur. Okay, let's talk about some other B -related allergies that I know very little about. For example, are there some people that are allergic to honey? There are, but it's less cases of actual allergy to honey, more actual cases of, say, botulism from honey that occur in the actual public than actual true honey allergy. That was my next question.

25:05 Why don't we feed honey to babies under the age of one? And such a beautiful and wonderful question. And that is definitely cases of botulism that used to occur. We are seeing currently, and this is I'm glad we're bringing it in on your podcast as well, too. Secondary to a baby formula, now there's four cases that have occurred secondary to a botulism, secondary to this actual infant formula that can occur. So this is why it's so important that we also keep honey out of baby's diets during the first year. Okay, how about other B -related products or what we call hive -related products? For example, propolis and royal jelly and things like this that people are often using in a quasi -medical sense or a health sense. What do you know about those?

25:57 As a lapina doctor, I know a lot of the home run that he's involved in. And obviously we all know, for example, honey in your tea, right? For that sore throat that actually occurs every single year for the flu, et cetera. We also know the medicinal properties of honey that can have, right? So one is that's a beautiful one. The soothing of the throat when you're sick, decreasing of the mucus that actually occurs with honey. But then there's other. and things that honey's used for. So a lot of people also who might have bad environmental allergies feed it to their kids as well too. And they say, well, it's gonna help them to develop some sensitization so that way they're less allergic to the environment as well too. So using it as a medicinal property.

26:43 doesn't have much data when it comes to it but I never deter people from doing it because honey obviously is something good for you as well too. So honestly I love the mix of western and a little bit of eastern medicine and I think it brings a lot to the table. That's actually why I got into beekeeping in the first place. I have pretty major seasonal allergies to you know tree pollen and grasses and all kinds of things and so I had read a whole bunch of stuff about eat raw honey and they'll go away. Well it's obviously not anywhere near that simple but here's what I did and again this is not research this is just one person's experience. I bought honey from raw honey from a beekeeper about 150 miles away from where I live and religiously had like a spoonful of this every day for a few months.

27:37 Allergy season came along It did nothing. It didn't help me at all. As I did a little bit more of my own research, what I read was how important the hyper locality of everything is. If the bees are foraging right around where I live. I may get more of that pollen that then is going to desensitize my allergies some. And that is exactly what happens. That's why I got into beekeeping. I eat my own raw honey and the allergies are not gone. But literally, Dr. Mora, they're like 50 percent better, which to me is a big deal. That's beautiful. Absolutely. So it worked somewhat for you, which is great. And that's why, like, I don't take it away from people.

28:22 I think it's a wonderful mix. Like, we can do the raw honey. We can do the antihistamines. It all works. Yeah, but I'd rather not have to take so much antihistamines. Yeah, I know. Okay, last thing. And you don't have any of your own beekeeping experience, do you? No, I wish I did. My grandfather did in Mexico back when I was a little girl. We can get you set up even in Chicago. Oh, I love it. I would love it. Every guest that comes on the show, and 99 % of them are beekeepers, I give them an opportunity to talk about a wild and crazy beekeeping story. Something that is funny or just crazy or painful or embarrassing. As an allergist, an allergy doctor, I'm going to give you the same opportunity.

29:12 If you're allowed to, you don't have to use any names or anything. What kinds of crazy Allergic reaction and things with patients do you run into? Well, I think I'm going to speak from the experience of my grandfather because I was a six year old little girl. I visit him in Mexico. He had a beehive. He loved his bees, et cetera. And I was a very, you know, I would run around a lot and just not a sit down little girl. I sat down on a beehive. And I got probably about a hundred things Now, you know what makes this funny is look who got actually stunned so much Completely had to get antihistamines etc and then became an allergist Just as a little bit of practical advice for anybody out there beekeeper or not when they get stung by a bee Are there any recommendations? I mean I've heard Benadryl.

30:14 I've heard ice. I've heard other things. What would you recommend? So I always tell my patients, especially those that get on a big allergic reaction, is making sure that they do, for example, they can double up their antihistamine on the day they're going to be outdoors, right? So if they're going to go to that picnic or the kids aren't at camp or they're going to go see their grandpa who's a beekeeper, etc. This might be a good time to basically help to decrease any local reactions by doubling up their antihistamines for the day. I like ice on the actual sting when it occurs and then a little bit of hydrocortisone cream, which basically helps to decrease the reaction and doing a dose of antihistamine if they haven't had one. We're kind of yielding away a little bit from Benadryl as a short -acting because of the side effects, sleepiness, etc.

31:04 So then I tell adults or kids to do a dose of Zyrtec or Zyzo or Allegra or anything that's a little bit long -lasting to kind of help to decrease the reaction. OK, I appreciate that. Is there any other wisdom you want to share with us before we let you go? Well, I definitely want to make sure that, you know, beekeepers, I obviously respect all the work, wonderful work that you do for our country, but I want you to keep safe. Please have an epinephrine device. at your workplace, have pediatric dose, have an adult dose as well to get it from your doctor, very important, could save your own life. And your life is priceless.

31:45 So I always say, do it, get it. The other thing is making sure that you use it in case of a severe allergic reaction or any two systems involved. Don't hesitate. You'll never be wrong for using it because it's better to be safe rather than sorry. Then the third thing, continue the protective gear because it's so important as well too. And continue to educate as well to other beekeepers and keep a podcast like this one, which is amazing, that helps to keep everyone safe because at the end of the day, I love working. towards public health in terms of making sure that we save as many lives as possible. And we're trying. I'm so happy that Nephi's out on the market because it's about saving lives. We don't want those 72 lives lost every single year due to bee sting allergy. We need to save more people. And having an epinephrine device at hand will do that. Thank you, Dr. Mora. I appreciate you being with me.

32:46 Oh, you're welcome. Have a beautiful day, everyone. Thanks again for joining us on Be Love, Be Keeping presented by Manlike. Another big thank you goes to V2B Health for their support. Vita's Varroa Control Ranger products includes Epistan, Epigard, and now Varroxan Extended Release Oxalic Acids Trips. Hey thanks a lot guys. And if you haven't yet, please subscribe to and follow the show, tell your friends about it, and click on over to BeLoveBekeeping .com to sign up for our free newsletter. If you have a guest suggestion or topic you'd like discussed on the show, shoot me an email, eric at BeLoveBekeeping .com. And remember if you're not just in it for the honey or the money, you're in it for the love. See you next week.