Bee venom anaphylaxis at a Northern Cape winery in South Africa and an inadequate emergency response: a near fatal combination
Keywords: work induction, bee sting allergies, Hymenoptera venom allergy
AbstractBackground: Bee venom allergy is an important cause for anaphylaxis and may have potentially fatal consequences. At-risk occupations include florists, horticulturists, farmers, bakers, fruit sellers, foresters and beekeepers. Control measures include changing jobs, wearing protective clothing, controlling the distance between beehives and the work place, and farming with less aggressive species. Management of a sting depends on the severity of the response and ranges from local topical treatments to intensive care admission for anaphylaxis. Findings: The patient had an anaphylactic reaction and epinephrine was not timeously administered because the nursing sister was not familiar with the use of the EpiPen®. The viability of the nursing sister’s thumb was threatened after she accidently dispensed the epinephrine into her thumb as a result of her panic. Hospital management was prompt and both patients were treated appropriately. The nursing sister had an informal meeting to address the incident but was not issued with a warning. The patient was re-instructed on the use of the EpiPen® and continued working in his job. Conclusion and recommendations: In this case, venom desensitisation should be considered, and it is questionable that the man should continue working in this environment. The patient had near fatal consequences as a result of poor initial emergency care management. New nursing personnel need to be adequately inducted on the first day of a new job; this cannot be delayed as in this case. Workers with known allergies to bee stings need to be frequently re-instructed on the use of self-injectable epinephrine; co-workers should also be trained.
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