Well known Sonoma racer died from swallowing bee/bug

[litcrazy]

This is so useful. And a bit overwhelming as someone who loves hiking, remote, riding, bikepacking and backpacking.

How ineffective are antihistamines? I’m asking someone who doesn’t have any _known_ allergies. Nor do my family members and riding buddies. But you hear of various first-time severe reactions and now I wonder if it’s worth getting a prescription for an epipen to carry. Or two. But they only last a year, are expensive and only last a year. Carrying Benadryl seems less effective than I’d thought.

Lots to consider.

Originally Posted by thwart

Good to know that’s current wilderness med training. Agree, good discussion. Thank you for your input.

Current ER treatment protocols are moving to larger and repeated doses of epinephrine with antihistamines (and steroids) definitely taking more of a back seat than a few years ago.

And to speak to the ER cost issues…. that’s one of the reasons some folks with early anaphylaxis wind up at an urgent care clinic. Not a good idea.

[Black Dog]

Originally Posted by teleguy57

@thwart and @Black Dog, you gents are an outstanding example of the quality of people and discourse here. I'm grateful to hang out in this forum with folks like you!

I'm also learning on this topic. Last wasp stings two years ago resulted in pretty severe localized reaction. Had some allergy testing done (unrelated) a year ago and it showed severe allergies to hornet/wasp/etc venoms (not bee). Since then I've been carrying an Epipen with the understanding it is to hold things off while getting to definitive care.

I was a ski patroller for about 15 years and stopped about 5 years ago. My biggest regret is not losing the free skiing, but the annual Outdoor Emergency Care refreshers to keep my first responder skills up. Seeing Black Dog's reference to wilderness responder certification has me thinking I should check out training options.

Again, thanks for the quality of your insights and the quality of the conversation!

Look up Wilderness Medical Associates for training opportunities. They are the best. Disclosure: I am not directly affiliated with them, but my wife was a former instructor. Worth taking even a basic course for those who spend time in the outdoors. The focus is on assessment/treatment skills and stabilizing victims for extended periods of time until they can be brought to a medical facility. Help is not always 5 minutes away and knowing what to do after minute 5 is what matters. Most standard first aid courses have become laser focused on calling 911 and facilitating the arrival of an ambulance and less so on anything beyond the ABC's (airway, breathing, and circulation) and CPR.

[thwart]

Originally Posted by litcrazy

I’m asking someone who doesn’t have any _known_ allergies. Nor do my family members and riding buddies.

Certainly no expert here, just stuck my nose in so we wouldn’t have folks thinking that carrying a couple of Benadryl makes a second Epipen superfluous.

I’d recommend you talk with your PCP.

But given the info you mention above, it seems the downside (cost, expiration issues, etc) may outweigh the upside.

That said, ‘radsmd’ mentioned above that he carries an Epipen just in case he needs to be a good samaritan.

And I’d second what ‘Black Dog’ posted. That training is a great idea.

[benb]

I think most of us can't actually legally put an EpiPen in an emergency first aid kit cause you need an Rx and if you don't have an Rx you have to be in some kind of approved position in a medical/rescue org.

Maybe that means the anti-histamines are at least worth putting in an emergency kit as it's better than nothing? (Is it better than nothing?)

[Black Dog]

Originally Posted by litcrazy

This is so useful. And a bit overwhelming as someone who loves hiking, remote, riding, bikepacking and backpacking.

How ineffective are antihistamines? I’m asking someone who doesn’t have any _known_ allergies. Nor do my family members and riding buddies. But you hear of various first-time severe reactions and now I wonder if it’s worth getting a prescription for an epipen to carry. Or two. But they only last a year, are expensive and only last a year. Carrying Benadryl seems less effective than I’d thought.

Lots to consider.

Antihistamines are effective are treating histamine reactions that effect the skin (hives, local reaction to an insect sting/bite etc..). If you or those that you spend time with have no know reactions or a family history of reactions the risk is probably very low, especially if you are within the 911 umbrella. If you are venturing farther afield and quick access from first responders is difficult an epipen(s) carried "in case" may be more prudent. They last longer than you might think, (the one year expiration date is very conservative), studies have shown that epinephrine will retain most of its potency for many years. As long as the window in the pen shows that liquid is clear it is good to go. I replace mine after 3 years even though I know they are likely still effective. Epinephrine stored in an ampule will remain effective for over a decade. I carry 2 epipens and on longer trips with more people I carry some ampules and syringes with the epipens (I am trained to calculate dosage when administering from an ampule).

[froze]

Originally Posted by rwsaunders

Expiration date is a year, but there is a note on the pens saying that if the liquid is clear, they’re still good. When there was a shortage a few years back, I received notices from the manufacturer extending the expiration date another year…safety factor I guess.

Good info, thanks, I may buy one since I go camping on my bike, and there are a lot of other campers, never know when someone might be in danger. I've never had an allergic reaction to any thing, bugs or otherwise, but as a person gets older the body changes, so one can never be certain.

[Black Dog]

Originally Posted by benb

I think most of us can't actually legally put an EpiPen in an emergency first aid kit cause you need an Rx and if you don't have an Rx you have to be in some kind of approved position in a medical/rescue org.

Maybe that means the anti-histamines are at least worth putting in an emergency kit as it's better than nothing? (Is it better than nothing?)

Go to your family doctor and ask for a script for an epipen, Tell them you want one in case you need one when you are away from 911 help. Most family docs I have worked with here in Canada will do this, especially if you have kids and ask for the Epi-Junior pens. It may be different in the states do to the litigious nature of your cultural and legal systems. I won't even get into the fact that the same pens cost several times more in the states than here.

As for giving it to someone else that is a grey area legally if they are conscious and way murkier if they are not. Where I live you can lend someone your epipen as long as they administer it themselves. You can assist them by holding your hand over theirs. I have done this more than once. If they consented to using your epipen and then lost consciousness it is legal here to administer it on their behalf. I would suggest strongly that anyone who carries one take a standard 1st aid course where they teach you how to use it and when. Most Good Samaritan Laws in North America will protect you under these circumstances.

Antihistamines are always worth having. However, note that Benadryl is sedative and under certain circumstances this can be an issue. Cetirizine (up to 20mg) (Brand names: Zyrtec, Aller-Tec, Quzyttir, All Day Allergy) is very well tolerated, more effective that Benadryl, and generally non sedative.

[litcrazy]

Thansk so much for the detailed answers. I’m learning so much
I’ve done the 16 hour wilderness first aid class three times but it’s been a few years now since before the pandemic. I’m a big fan (and needed that training to lead backpacking trips… and likely should have been required to have woofer training in reality). I want to take the 16 hour course again with my 19 and 22 year old outdoorsy kids and that will be a pretty penny. But worth it.

Following up a bit. I had mistakenly thought Benadryl was more effective than Zyrtec for non respiratory allergy reactions such as insect bites/stings.. I’ll happily switch to Zyrtec as many of many family members are super sedated by Benadryl.

Here’s my question though:If you already take Zyrtec on the daily for hay fever, how does that play into taking it after a sting? I’m thinking a for both a very local itchy reaction and a larger reaction. Even a local but extremely itchy reaction distracts on a ride.

[froze]

I carry Benedril just in case I have some sort of reaction to something.

I'll ask my doc the next time I see him if he could write me a script, just kind of wavering on the whole idea because I've never needed it in 50 years of riding, nor have I known anyone who needed it. But all it takes is that one time.

Some things we simply can't be prepared for, we can't carry a Defibrillator. I brought that up because I ran into a situation 3 months ago on my bike where that would have been nice to have, but it may not have worked anyway, all I could do was call 911 and start CPR. I saw the guy as I was approaching a bench in a park, he suddenly just fell off the bench onto the ground, I thought maybe he fell over drunk, but I stopped and he had no pulse, called 911 and put the speaker on while I was doing CPR. The cops and paramedics arrived about 5 minutes later and they took over, shocked him a bunch of times, and injected him with a couple of things, but he didn't make it. The EMTs won't tell you someone died that they are working on, they just pretend to keep working on someone till they get them in the vehicle and leave, and then they stop. At least that's how they do where I live. But I knew the guy was dead, no pulse ever came back and he'd been in that state for the 5 min while I worked on him, and for an additional 15 min the EMT worked on him, that's 20 min without a pulse. A nurse just happened to be out running while I was doing CPR and she kept checking his pulse and took over the phone so she could talk to them, and let me continue the CPR, she said before the EMT even arrived it was doubtful they were going to be able to bring him back. A very nice lady that nurse was.

[froze]

Someone left a msg but deleted it, wonder what the difference is between Benadryl and Zrytec.

According to the internet, this is what I found.

Benadryl still holds preferential treatment for most allergic reactions. This is best exemplified by the ACIP (Advisory Committee on Immunization Practices) recommendations to use diphenhydramine (an active ingredient in Benadryl) for vaccine-induced anaphylaxis, although the specific recommendation is injectable diphenhydramine.

Both of them work the same, the differences are that Benadryl is more of a sedative than Zrytec is, though both have that effect, Zrytec is milder at it. Zrytec's protection will last to 12-24 hours, while Benadryl will work up to 4-6 hours. For some reason, Benadryl is the recommended agent of choice for vaccine-induced allergic reactions; Zrytec is better for reoccurring long-term allergic reactions.

Other than what I mentioned, the two are identical in how they work. I take Benadryl only because it doesn't make me sleepy, and it works, not sure how well Zyrtec works because I've never used it.

I use

[Black Dog]

Originally Posted by litcrazy

Thansk so much for the detailed answers. I’m learning so much
I’ve done the 16 hour wilderness first aid class three times but it’s been a few years now since before the pandemic. I’m a big fan (and needed that training to lead backpacking trips… and likely should have been required to have woofer training in reality). I want to take the 16 hour course again with my 19 and 22 year old outdoorsy kids and that will be a pretty penny. But worth it.

Following up a bit. I had mistakenly thought Benadryl was more effective than Zyrtec for non respiratory allergy reactions such as insect bites/stings.. I’ll happily switch to Zyrtec as many of many family members are super sedated by Benadryl.

Here’s my question though:If you already take Zyrtec on the daily for hay fever, how does that play into taking it after a sting? I’m thinking a for both a very local itchy reaction and a larger reaction. Even a local but extremely itchy reaction distracts on a ride.

For stings/bites I would use a topical cortisone cream or a Benadryl insect product that you rub over the bite and is in liquid form.

[cnighbor1]

Meat tenderizer works has it breaks down protein. And a bee sting is protein
It comes in a small packet in a powder from mix with water to from a paste and apply

[froze]

Originally Posted by Black Dog

For stings/bites I would use a topical cortisone cream or a Benadryl insect product that you rub over the bite and is in liquid form.

I forgot about that. When I go bike camping I have a roll-on tube of Benadryl just in case I get bit by an insect and it starts to itch.

[Spaghetti Legs]

When I was a kid we’d rub tobacco on bee stings. Worked really well.