Jamie Ellis has experienced thousands of bee stings in his lifetime. Ellis, a professor in the entomology and nematology department at the University of Florida, admits to experiencing between 400 and 450 stings in a single day while conducting research. Even after experiencing many stings, he says they are still painful.
“You never really get immune to the pain,” Ellis says.
Bees work hard to defend their hive, and causing pain to an organism they want to drive away as quickly as possible is their goal. Still, when stung, some individuals experience more than just pain: they might suffer an allergic reaction. In a 2022 study in Clinical Case Reports, researchers found that up to 5 percent of people in Europe and the U.S. have an allergic reaction to a bee or wasp sting, with varying degrees of severity.
“There's about five or six levels of reactions that one can have to stings of any type, and they're not all allergic reactions,” Ellis says.
What Causes an Allergic Reaction to Bee Stings?
Allergic reactions can stem from a variety of sources, including food, pollen or certain medications. Melinda Rathkopf, an allergist at Emory University, describes an allergy as “an immune-mediated reaction to a specific trigger.” In the case of bee stings, venom is that trigger.
"Venom from the bee or the wasp punctures the skin, and there’s a bunch of proteins called proteases that break down a ton of tissue and result in histamine release,” says David Sanchez, an allergist and immunologist affiliated with New York University School of Medicine. (Other chemically active substances are at play, too.) In most cases, a bee sting results in symptoms such as redness, warmth and itching.
For some of us, though, the immune system basically overreacts to the subsequent venom. "When the human protein binds to the insect protein, that causes the allergy,” Sanchez explains.
Read More: Everything to Know About Allergies
What Happens if You're Allergic to Bee Stings?
For those allergic to bee stings, that immune-mediated reaction can cause more serious symptoms. For example, Rathkopf once experienced a large local reaction when stung, and her rash swelled beyond the size of her palm.
A small percentage of people who are stung might experience other symptoms even further away from the sting site, which can include hives, nausea, vomiting, nasal congestion, coughing, wheezing, difficulty breathing and a drop in blood pressure. This type of severe allergic reaction to bee stings, known as anaphylaxis, is potentially life-threatening — and often requires emergency treatment.
Still, not all bee stings are created equal; the venom of, say, a honeybee is different from that of a wasp is different. So, just because you had an allergic reaction to a honeybee sting, doesn’t mean you are allergic to a wasp, says Patricia Lugar, chief of allergy and immunology at Duke.
In fact, researchers of a study published in the journal BMJ found that “patients allergic to wasp venom are rarely allergic to bee venom.”
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Why Do People Respond Differently to Bee Stings?
When it comes to why some of us experience a normal local reaction, and some of us experience an allergic reaction varying in severity, experts don’t have all the answers. “It's not entirely clear why some people develop an allergy,” says Sanchez.
Rathkopf has a similar response. “We really don't know why some people could be stung multiple times and have no problem ever, and someone can be stung one time and have a near-fatal or fatal reaction to stinging insects,” she says.
Part of the problem continues Rathkopf, is that there isn't really a good screening test for venom allergies. Stanford University allergist and immunologist Tina Sindher agrees, adding that better diagnostic processes are needed.
“Right now, it's almost like ‘Well, wait till you react for us to tell you what to do about it,’" says Sindher. "There's no way for us to predict how bad your reaction would be ahead of time."
What Can Increase Your Risk?
If a family member experienced a severe reaction, that could understandably create a cloud of anxiety and fear. But just because your parents or family members experience a severe allergic reaction to bees or wasps doesn’t mean you will. Likewise, testing isn’t necessarily recommended in this situation, due to the high rates of false positives.
Still, there are other factors that can heighten the risk. Some conditions such as having systemic mastocytosis, or other mast cell disorders, seem to increase one’s risk of having a severe allergic reaction.
What's more, if you've experienced a severe reaction to a sting, your chances of having a severe reaction the next time is about 50 percent, Rathkopf explains. Fortunately, Sanchez states, the data shows it’s unlikely that you will have a worse reaction than the first time.
Additionally, if you are taking medications like beta blockers and ACE inhibitors, some experts suggest that you may be at a greater risk for a severe reaction. However, Sanchez advises that there is conflicting data on this matter, as it is challenging to differentiate the effects of these medications from the underlying conditions of those taking them. For instance, certain cardiac conditions could contribute to a worse outcome.
How to Avoid an Allergic Reaction to Bees
Clearly, avoiding bees is your best bet to evade an adverse reaction, but this isn’t always possible. You might step on a bee accidentally, or stumble across a beehive without realizing it before it's too late.
The good news? Fatal reactions to stings aren’t common — there’s an average of about 72 deaths per year, according to the Centers of Disease Control and Prevention.
If you do experience a sting and endure symptoms worse than the typical pain, redness, itching and swelling, experts say seeking medical attention as soon as possible can be important — especially if you aren’t sure about the severity of your reaction — as life-saving medications are available.
“Epinephrine is the only proven thing that can actually stop an allergic reaction,” Sindher says.
If you’ve already had a reaction and you’re concerned, then Rathkopf recommends you talk to your provider to inquire about seeing a board-certified allergist.
At the end of the day, Ellis notes that a bee sting, or the associated venom, isn’t meant to kill mammals. “It's just designed to make us hurt,” Ellis adds.
Read More: Do Insects Have Feelings and Consciousness?