The class Insecta is the most highly represented of animal groups with no less than 4200 species being found on the Maltese Islands. Very few of these species are of any medical import often acting as carriers of disease; others have been used in therapeutics. The species that can cause direct harm to humans belong to the Order Hymenoptera including bees and wasps, which protect themselves and their colonies by the use of a sting injecting venom.

Clinical Features:

For many individuals, a bee or wasp sting is a minor annoyance and can be fatal in itself only if occurring in large numbers [hundreds in an adult]. However a number of individuals may suffer a variable allergic reaction to the inflammatory substance in the sting venom. The venom activates the body's immune system, which releases antibodies the counter the harmful effects of germs and toxins. However, some individuals release too much of this antibody bringing about a situation that can become life threatening. Allergic reactions to Hymenoptera stings are therefore more common in adults than in children because adults have had more of a chance to develop a serious allergy in the stings. Each subsequent sting usually results in a more serious allergic reaction in those already sensitized. The severity of the sting also depends on where it is located on the body; a sting t the neck can affect breathing, and swallowing a bee/wasp can cause strangulation if the animal stings the inside of the throat. [Wasps are fond of sweet alcoholic drinks, and picnickers should keep their eye out on their drinks, lest they imbibe a wasp together with their cool drink!]

• When stung, allergic individuals experience soreness and swelling not only at the site of the sting, but on other parts of the body as well. Symptoms in those who are allergic to stings include fever, chills, light-headedness, hives, joint and muscle pain, lymph node swelling and bronchial constriction. Other severe reactions include a sudden drop in blood pressure with loss of consciousness, difficult breathing, shock and occasionally death within an hour. Multiple stings - 30-40 stings - will cause a reaction even in an unsensitized individual, including chills, fever, vomiting, pulmonary edema, difficult breathing, a drop in blood pressure and collapse.

Treatment:
Certain types of clothing can serve to protect against stings - white or light-colored clothing with a smooth finish is less likely to excite bees/wasps to attack; leather is particularly irritating, but the insects will also become disturbed with bright colored dark rough or wooly material. Bees also seem to become irritated over perspiration odors, perfumes, suntan lotions and hair sprays. It is always best to remain motionless than to run [unless being pursued by a colony of bees or wasps!]. Do not swing at the animal but slowly retreat, with the face protected with the hands. Alternately, just lie face down. The best prevention however is to avoid disturbing bees or wasps nests.

• The bee, not the wasp, will often leave its sting sac in the wound; thus to treat the sting, remove the stinger by scraping it away with a fingernail or the edge of a knife-blade. Grasping it with the fingers or tweezers will only serve to inject further venom into the wound.

• Wash the wound with soap and water and apply antiseptic and a cold compress; ice will help to reduce the swelling.

• Pain and irritation can be relieved by applying a paste made from either baking soda and water, or meat tenderizer and water. The meat tenderizer - developed to break down protein - also neutralizes the bee/wasp venom. Bee venom is acidic and should be neutralized by the application of ammonia, backing soda or methylene blue. On the other hand, wasp venom is alkaline and requires acid such as vinegar or lemon juice for its neutralization. [Bicarbonate for Bee; Vinegar for Vasp!]. For stings in the mouth or throat, give the victim ice cubes to suck while seeking medical attention. An analgesic-corticosteroid lotion is often useful.

Those at particular risk [e.g. bee keepers] who have had a severe reaction in the past should carry an emergency self-treatment kit containing antihistaminic tablets, alcohol swabs and a pre-loaded syringe of epinephrine to counter the allergic response of the sting. Alternately they may consider taking immunotherapy using whole-body antigens or preferably whole-venom antigens.