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もしもにそなえておきたい 蜂毒アレルギー
蜂毒アレルギーの症状
蜂毒アレルギーは、蜂に刺されてから短時間で症状があらわれるのが特徴です。
症状があらわれてから心停止まで約15分
蜂毒に特有なのは反応時間が早い点で、蜂に刺されてからその多くは約15分以内には症状が出てきます。症状が早くあらわれるほど重症になることが多く、場合によってはアナフィラキシーショックを起こします。さらに、アナフィラキシーの症状が出てから心停止までの時間は15分という報告があり、速やかな治療が必要です。
医療機関から離れた山間部などで蜂刺されにあった場合は、救急車の到着までに時間がかかることが多く、アナフィラキシーショックにより命を落とすリスクがさらに高まるため、対策が重要となります。
局所的な腫れから、重い全身症状まで
蜂に刺された場合に、蜂毒にアレルギーがなければ、刺された箇所に軽い痛みやかゆみ、腫れなどが起こり（局所症状）、数日程度で消えていきます。
しかし、蜂毒にアレルギーがあると、刺された人の約10～20％が、全身のじんましんなどの皮膚症状や嘔吐、浮腫※、呼吸困難などが起こるアナフィラキシーを引き起こすといわれています。そのうち、数％は意識障害や急な血圧低下によるアナフィラキシーショックを起こすとされ、命に危険がおよぶ確率が高くなります。
また、短期間に2回蜂刺されにあうと、アナフィラキシーを起こしやすくなるという調査もあります。なお、子どもの場合は重いアナフィラキシーに至るのは1％程度と考えられています。
初めての蜂刺されでも死に至るケースが
アレルギー症状の多くは、体内に蜂毒に対する抗体ができた後、2回目以降に蜂毒が入ったとき、もともと身体の中に存在する主にヒスタミンという物質の作用によって、全身症状が引き起こされます。
しかし、蜂毒にもこのヒスタミンが少量含まれていることから、多量の蜂毒が同時に体内に入った場合、初めての蜂刺されでもアレルギー様の症状を起こすこともあります。
蜂刺されで死に至るのは、複数回刺された場合よりも、初めて刺されたケースの方が多いという報告もあります。
監修
獨協医科大学埼玉医療センター 呼吸器・アレルギー内科 准教授 平田 博国 先生
https://allergy72.jp/bee-allergy/symptom.html
蜂に刺されないためには、蜂の習性を知ること、蜂に近づかないことが大切です。
蜂毒アレルギーへの対策
「近づかない、触らない」が基本
毒針を持つ蜂でも、こちらから刺激しなければ、刺されることはまずありません。蜂が相手を襲うのは、巣が攻撃されて危険を感じたとき。蜂に刺されないためには、「蜂に近づかない」、「巣に近づかない」、「蜂や巣に触れない」を守りましょう。
自宅で注意したいこと
靴の中、洗濯物や布団を取り込むときには、蜂がひそんでいないかよくチェックしてから取り込みましょう。アシナガバチやミツバチは民家やその周辺に巣をつくる習性があり、日当たりのよい洗濯物などにとまっていることがあります。
蜂が家の中に入ってきたときは、蜂を刺激してはいけません。明るい方の窓や玄関のドアを開け、自然に外に出るのを待ちましょう。
蜂は巣を守る本能が強く、巣を攻撃されると興奮するため、むやみに近づいたり、棒でつついて落としたりすることや殺虫スプレーを散布することは、絶対に避けましょう。
アウトドアや山で注意したいこと
一番よいのは蜂がいるような場所に近寄らないことですが、屋外作業や山歩きなど、蜂がいそうな場所に行くときは、服装を工夫することによって蜂を避けるようにしましょう。
蜂は黒っぽい色に向かって攻撃したり、甘い匂いに誘われたりする習性があります。それらを避ける服装や持ち物が望ましいでしょう。また、顔や首、腕、足など、露出した部分が真っ先にねらわれるので、なるべく肌を覆う服装を心がけましょう。
蜂に刺されないために
*服装は白っぽい色や明るい色の長袖を選ぶ。なるべく肌を出さない。
*黒いバッグ、黒いカメラなど、黒いものは持たない。
*花柄の服装、花柄のバッグなども避ける。
*甘い香りのする香水や整髪料はつけない。
蜂に攻撃されたら
蜂が向かってきた時に、手でふりはらったり大声をあげたりすると、かえって蜂を刺激します。目を閉じて、顔を下向き加減にし、身を低くしてじっとしていましょう。興奮した蜂に刺激されて、他の蜂が集団で襲ってくる場合もあります。走らないよう、速やかに、その場から離れてください。
蜂に刺されたら、直ちに最寄りの医療機関を受診し、医師による適切な処置・治療を受けるようにしてください。
監修
獨協医科大学埼玉医療センター 呼吸器・アレルギー内科 准教授 平田 博国 先生
https://allergy72.jp/bee-allergy/prevention.html
蜂叮
立刻要做的事：用鑷子把尾刺或毒針拔除，再冰敷。
被蜂叮會有哪些狀況？
定義：
被蜂叮或咬皆屬蜂叮，主要的重大傷害以虎頭蜂（胡蜂）螫傷為主，其中以黑腹胡蜂毒性最強。
臨床表現：
其臨床表現主要分為下列三種：
1.非過敏性反應：被叮咬的地方會出現疼痛、刺激感、癢及紅腫的症狀。而大多的症狀會在數小時內緩解。
2.毒性反應：常發生在被多次叮咬之後，這是因為毒素的累積而引起，它的症狀包括水腫、倦怠感、嘔吐、腹瀉、頭痛、低血壓、抽筋、意識不清及急性腎衰竭；少數病人還會有延遲性反應，包括溶血反應、凝血異常、血小板減少、橫紋肌溶解、肝功能異常及瀰漫性血管內病變等。
3.過敏反應：只對毒素中的物質過敏所引起，局部反應及全身性過敏反應皆可見，包含蕁麻疹、血管水腫、上呼吸道水腫、氣喘、支氣管緊縮等等類似氣喘反應，嚴重者會引起低血壓、休克而死亡。
要怎麼預防才好？
從虎頭蜂的生活史來說明，新蜂王大約從每年三至四月份開始建立它的巢穴，蜂巢逐漸增大，族群逐漸增多，到了四、五月份可能增加到千餘隻，到了九至十一月份時蜂群已增加到近萬隻，此時蜂群較不穩定，一方面幼蟲生產過多，食物需要量增大，但野外食物來源卻漸漸減少，幼蟲可能因發育不良而死亡；另一方面有新蜂王產生，新勢力形成，使得蜂群的攻擊性變強，最容易發生螫人的情形。
一般人要注意的，首先就是避免蜂螫，尤其是在蜂群最多、最不穩定的九至十一月。避免用化妝品、香水、髮膠，穿深暗色貼身而不寬鬆的衣服，都可以減少被蜂螫的機會。當您發現自己被一隻虎頭蜂盯上的時候就必須注意，不要隨便亂動，觀察附近是否有蜂巢，靜靜離開，不要讓牠認為您有敵意，否則一旦被攻擊，很可能就是一大群蜂擁而上。如果附近只有一隻，但不幸被螫，就要趕快離開現場，避免被後來的一群虎頭蜂趕上。
我該怎樣照護自己？
以症狀治療為主，可以冰敷患部，服用抗過敏藥物、止痛藥物等。而在拔除具毒性的尾刺時，由於其上有毒囊，為避免拔除時擠破，要避免直接以手拔除，而需以刀片鈍部或鑷子慢慢拔除。
什麼時候需要找醫師？
有上述嚴重的全身性過敏反應及毒性反應時，應尋求醫療幫助。
⟡ 提醒您
被蜂螫之後，最怕的就是急性過敏反應，尤其是有被蜂螫病史的人，即使被一隻螫到也可能發生，而且往往在數分鐘內就會發生，最好能就近送醫，避免造成悲劇。為防止過敏性休克產生，曾有急性過敏反應的民眾，到易有蜂聚集的野外時，建議隨身攜帶腎上腺素製劑，以備緊急時使用。
https://www.nhi.gov.tw/Content_List.aspx?n=239E6ADA32BF06EB&topn=3185A4DF68749BA9
Anaphylaxis: What you need to know about life or death allergic reactions
Anaphylaxis requires immediate medical treatment, including a prompt injection of epinephrine and a trip to a hospital emergency room. If anaphylactic shock isn't treated immediately, it can be fatal.
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What is anaphylaxis?
Anaphylaxis is a serious allergic response that often involves swelling, hives, lowered blood pressure and in severe cases, shock and death. Anaphylaxis requires immediate medical treatment, including a prompt injection of epinephrine and a trip to a hospital emergency room. If anaphylactic shock isn't treated immediately, it can be fatal.
Isn’t this a FD/Paramedic issue?
Ideally, yes. However, if you are on patrol you may be the closest to respond to the 911 call. Anaphylaxis is a severe and sudden allergic reaction. It occurs within minutes of exposure to an allergen. If not treated appropriately, anaphylaxis can turn deadly very quickly. Anaphylactic shock can also occur while a suspect is in your custody both in or outside of a detention facility.
Additionally, failure to recognize anaphylaxis and to seek prompt, appropriate treatment tends to upset everyone who has more stripes or stars than you do, elected officials, and family members as well. This is truly an ounce of prevention and quick action scenario.
What are the symptoms of an anaphylactic reaction?
The major difference between anaphylaxis and other allergic reactions is that anaphylaxis typically involves more than one system of the body.
*Red rash (usually itchy and may have welts/hives)
*Swollen throat or swollen areas of the body
*Wheezing
*Loss of consciousness
*Chest tightness
*Trouble breathing
*Hoarse voice
*Trouble swallowing
*Vomiting
*Diarrhea
*Stomach cramping
*Pale or red color to the face and body
It is important to remember that, like other allergic reactions, an anaphylactic reaction does not usually occur after the first exposure to an allergen but after a subsequent exposure. You may have an allergic reaction to a bee sting, but the next sting could lead to anaphylaxis.
What causes anaphylaxis?
Food allergens are the most common cause of anaphylaxis. An estimated 15 million people have food allergies; 9 million adults and 6 million children have food allergies in the United States. Young children are the most affected. Emergency department visits for food-induced acute reactions occur about every 3 minutes; and visits for food-induced anaphylaxis occur every 6 minutes. According to the CDC these rates are increasing. Approximately 20-25% of epinephrine administrations in schools involve individuals whose allergy was unknown at the time of the reaction. The main culprits for food allergies are cow’s milk, eggs, fish, shellfish, peanuts, tree nuts, soy and wheat.
Stinging insects are another common cause of anaphylaxis. It is estimated that potentially life-threatening systemic reactions to insect stings occur in up to 1% of children and 3% of adults. Hymenoptera is the name for the order of stinging insects that cause allergies, which include five species: honeybees, yellow jackets, paper wasps, hornets and fire ants. Hymenoptera stings account for more deaths in the United States than any other venomous animals, accounting for at least 40 deaths annually.
Certain medications can also cause an anaphylactic reaction; these include antibiotics (amoxicillin, ampicillin, penicillin, tetracycline), aspirin and other over-the-counter pain relievers (ibuprofen and naproxen), sulfa drugs, chemotherapy drugs and the intravenous (IV) contrast used in some imaging tests. Make sure if you have allergies to any medications that it is noted on your medical records, including the symptoms of the reaction you have. Wear a medical alert bracelet as well.
Latex can also cause allergic reactions that range from mild to deadly. Latex is found in many forms, not just gloves, but that is where you and the medical community will most likely have contact with natural rubber products. Latex can be found in tennis shoes, balloons, condoms, tires, chewing gum, and the scratch-off portion of the instant lottery ticket.
What is the protocol if you arrive on the scene of someone in anaphylactic shock?
1.Intramuscular (IM) epinephrine is the first-line treatment in all cases of anaphylaxis. Because anaphylaxis symptoms may progress rapidly and become life threatening, it is important that treatment with epinephrine be initiated promptly. Ascertain if the subject or a companion or a family member has an immediate access to an EpiPen. EpiPens are spring loaded autoinjectors designed to deliver a specific dose of an epinephrine base on a patient’s weight. If they do, or have, assist them or administer epinephrine into the muscle in the upper, outer thigh.
2.Call for additional help AFTER delivering epinephrine.
3.Eliminate additional allergen exposure. Remove food from the mouth and teeth. If the allergic reaction is from a bee sting, scrape the stinger off the skin with something firm (such as a fingernail or plastic credit card). Do not use tweezers. Squeezing the stinger will release more venom.
4.Check the person's airway, breathing, and circulation. A warning sign of dangerous throat swelling is a hoarse or whispered voice. If necessary, begin rescue breathing and CPR. Do not place a pillow under the person's head if they are having trouble breathing; this can block the airways. Do not give the subject anything by mouth if the person is having difficulty breathing; this can lead to choking and asphyxia.
5.Take steps to prevent shock. Have the person lie flat, raise the person's feet about 12 inches (30 centimeters), and cover the person with a coat or blanket. Do not place the person in this position if a head, neck, back, or leg injury is suspected, or if it causes discomfort.
6.Do not assume that any allergy shots the person has already received will provide complete protection. A second dose of epinephrine may be required in up to 20% of cases of anaphylaxis
7.Paramedics or other EMS providers may place a tube through the nose or mouth into the airways. An emergency tracheotomy may be required
8.The subject will require emergency follow-up at the nearest hospital ER.
9.Try to calm and reassure the person and any companions.
10.After the medical crisis is over the subject will be referred to an allergist/immunologist for an accurate diagnosis and appropriate prescriptions.
How does epinephrine work during an anaphylactic reaction?
No other medicine acts on so many body systems as epinephrine, which is why it is the drug of choice for anaphylaxis.
1.It causes constriction, or tightening, of the blood vessels, which decreases swelling and also helps to increase blood pressure.
2.It increases the heart’s contraction and heart rate, which can help to prevent or reverse cardiovascular collapse.
3.It relaxes the muscles around the airways in the lungs, helping the airways to open up.
4.It prevents the release of additional allergic chemicals, which aids in stopping further progression of the reaction.
Note: A severe allergic reaction may sometimes last hours. Epinephrine works quickly but may only last for 15 to 20 minutes. If a patient responds poorly to the initial dose or has ongoing or progressive symptoms a second dose may be required after 5 to 15 minutes.
I’m a K-9 handler: Can my dog have an anaphylactic reaction?
The most common symptoms of anaphylaxis in dogs include the sudden onset of diarrhea, vomiting, shock, seizures, coma, and death. The animal's gums will be very pale, and the limbs will feel cold. If you know that your dog has had a history of allergies (often insect stings) an EpiPen or syringe of epinephrine should always be kept with you. Dogs weighing over 45 lbs. can use the standard 0.3 mg epinephrine EpiPen (adult’s dose) or 0.15mg (child’s dose) for dogs weighing less. The dog often requires close hospital monitoring for 24 to 48 hours after the reaction and may require life support.
Should law enforcement officers be allowed to carry epinephrine auto-injectors?
Illinois thinks so. As of Sunday, January 1, 2017 the Annie LeGere law (Bill HB 4462) went into effect in that state, and will likely save lives as first responders will have access and training to administer epinephrine. Will other states follow suit? Questions about the costs of training and EpiPens themselves (at about $600 for a 2-pack), as well as liability will obviously be issues that will need to be explored.
Can I be an officer if I have a history of severe anaphylactic reactions?
Of course; you know better than anyone how to prevent reactions, and how to treat them. However, make sure you let your partners and supervisors know your medical condition. If you are allergic to yellow jackets and are stung while on duty carry an EPI pen on your vest through the Velcro straps, and make sure everyone knows where it is. Carry your back-up as well in case a second dose is needed.
Are all state laws related to access to epinephrine at schools, camps, restaurants, etc. the same?
No, not even close. I strongly suggest you review these two websites related to the epinephrine stocking and school access laws in your state.
1.Epinephrine Entity Stocking Laws in the U.S. (https://www.networkforphl.org/_asset/8483ms/Issue-Brief-Epi-Entity-Stocking.pdf)
2.School Access to Epinephrine Map (https://www.foodallergy.org/advocacy/epinephrine/map)
Are there any tips to prevent allergic reactions and anaphylaxis?
*Avoid triggers such as foods and medicines that have caused an allergic reaction in the past.
*Ask detailed questions about ingredients when you are eating away from home. Asian restaurants and bakeries who use nuts are of concern.
*Notify hosts/hostesses of allergies. If in doubt, bring your own food.
*Carefully examine ingredient labels.
*If you have a child who is allergic to certain foods, introduce one new food at a time in small amounts so you can recognize an allergic reaction.
*Individuals who know that they have had serious allergic reactions should wear a medical ID tag.
*Make sure all medical providers and pharmacies are aware of your allergies.
*If you have a history of serious allergic reactions, carry emergency medicines (such as a chewable antihistamine and injectable epinephrine or a bee sting kit) according to your provider's instructions.
*Check the expiration date of all emergency medications and be sure to refill your prescription before it expires
*Do not use your injectable epinephrine on anyone else. They may have a condition (such as a heart problem) that could be worsened by this drug.
*If you're allergic to insect stings, wear protective clothing when you go outside. Avoid shiny fabrics or jewelry, which can attract insects. Put a lid over sugary drinks.
*See a specialist for an accurate diagnosis and to obtain appropriate prescriptions.
https://www.officer.com/command-hq/supplies-services/healthcare/article/12326031/anaphylaxis-what-you-need-to-know-about-life-or-death-allergic-reactions
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創作內容
オオスズメバチが児童を襲う ２０人が病院搬送(過敏性休克.アナフィラキシー)①
人と動物の共通感染症 (165)
