in a world brimming with complexity few creatures
embody harmony like the honeybee with tireless
precision she dances from bloom to bloom each
motion guided by millennia upon millennia of
instinct each act in service to the whole and
then There are the beekeepers, watchful stewards
of this ancient symbiosis. Part agriscientist,
part poet, they move along their hives with the
efficiency of mow, levy and curly, tending to
the bees' needs as best they can comprehend,
and with the infrequency of a waterfall in the
Sahara, sometimes running off flapping and flailing
like a penguin on a hot sidewalk. This is their
journey. Welcome, welcome to Be Love Beekeeping
presented by our good friends over at Man Lake.
Today's expert guest is a board certified allergy
doctor and allergist. We will be discussing everything
about bee sting allergic reactions and what you
can do to save a life. This may be the most important
beekeeping podcast you have ever listened to.
Be sure to share it with your beekeeper friends.
But before we go to our discussion with Dr. Mora,
let's take just a couple of minutes. for some
interesting facts about bee stings and bee venom.
Number one, bee venom is mostly one protein.
About 50 % of bee venom's dry weight is melaton,
the peptide responsible for most of the pain
and tissue damage from a sting. It's actually
one of the most studied venom peptides in biology.
Two, only female bees can sting. The stinger
is a modified, oh I hope I can pronounce this
correctly, ovipositor or egg -laying organ. So
drones, which are all boys, have no stinger and
can't sting at all. Number three, worker bees
die after stinging but queens don't. A worker's
barbed stinger lodges in mammal skin and rips
out part of her abdomen when she pulls away.
But queen bees have smoother stingers without
the barbs. These are designed for fighting rival
queens, not for defense of the hive, so they
can sting repeatedly and survive. However, there
are some exceptions if a worker bee stings something
with thick or leathery type skin. like another
insect or thick clothing. Rather than mammal
skin, the barbs may not catch, letting the bee
escape and sting again. Number four, the stinger
keeps pumping venom after detachment. Once a
worker bee stings and the stinger tears off,
muscles attached to the venom sac keep contracting
for a few minutes, pumping in more venom even
though the bee itself is gone. That's why beekeepers
know the best thing to do is to scrape a stinger
out quickly rather than pinch it. Number five,
venom triggers an attack me alarm pheromone.
Isopental acetate, a component released alongside
the sting, smells a little like bananas and signals
other bees to join the attack on the same target,
which is part of why beekeepers avoid eating
bananas near their hives. Number six, bee venom
is used as a real medical treatment. Purified
bee venom is used in allergen immunotherapy shots
to help people build tolerance and reduce the
risk of severe allergic reactions to future stings.
Number seven, melaton is being studied for medicinal
uses beyond just allergies. Researchers have
investigated melaton's potential effects on bacteria,
viruses and even cancer cells in lab studies.
Though it's still an active area of research,
there aren't any approved applied treatments
quite yet. And lastly, number eight, temperature
and bee mood can affect the venom yield and therefore
affect the sting itself. Bees can produce different
yields depending on colony health, season, and
stress levels. So if you've ever had a much bigger
reaction and more pain from one sting versus
another, there really is actually a reason for
it. It can be a real thing. I'd like to welcome
our very special guest today. We have Dr. Juanita
Mora coming to us from, is it Chicago? Chicago.
Chicago, and she's an allergist and oh my goodness,
a wealth of information. I've been looking forward
to this a long time. How are you, Dr. Mora? Oh,
so wonderful to be with you and on this wonderful
podcast to help educate our public, which is
always one of my big passions. Allergies come
up all the time in beekeeping, well in talk about
beekeeping. And one of the things as a beekeeper
that non beekeepers ask us the most is, do you
ever get stung? And oh, I could never do that
because I'm allergic. So first of all, yes, we
get stung and it's okay. We don't really care.
But let's, where should we even start talking
about bee venom allergies? Where should we jump
in? Well, maybe how many people suffer in the
United States? So we know in the United States,
when we're talking people allergic to V -Venom,
we're talking about 2 million Americans. And
out of these 2 million Americans, we know that
20 % of all anaphylaxis or severe allergic reactions
happen in people who aren't allergic to V -Venom.
It accounts for 45 ,000 to 50 ,000 hospitalizations,
emergency department visits every single year.
and we lose 72 people secondary to fatal or mortal
bee sting allergy every single year, which is
why it's so important that we talk, especially
with people who work with bees and are beekeepers
year -round. I have so many questions. I'm going
to try to I'm going to try not to get ahead of
myself too far And so where I want to start is
let's talk about bee venom allergies because
some people have different kinds of reactions
localized reactions Some people have a reaction
that is not localized For example, they get stung
on their thumb and they get hives on their back
And then other people have a real anaphylactic
reaction. Can you take those three things and
let's put the proper terminology to what we're
talking about. Absolutely. So when a person comes
in to be evaluated for a bee sting or any insect
sting. First thing, you know, taking the histories.
So a lot of people get what's called a large
local reaction right where they get this thing.
They get an actual big hive that occurs right
at the area. And sometimes it extends in the
arm, but that's where it stays. It doesn't go
into full body hives. There's no throat swelling.
There's no eye swelling or anything. Then basically
there's people who have a non -localized reaction
like you described where they might get stung
on their wrist and then they develop hives on
their legs or different things. But again, just
one localized area. When it becomes anaphylaxis
is where we're looking at two or more systems
involved or anything like threatening. Two or
more systems involved might be breaking out in
hives and lip swelling. Breaking out in hives
and eye swelling. Breaking out in hives and vomiting.
Or anything life threatening. Feeling like your
throat is closing. Swelling obviously of the
tongue that can actually occur as well too. Shortness
of breath or wheezing or dizziness and feeling
like you're about to pass out. It's called anaphylaxis
and at that point we need epinephrine. Okay.
How does somebody know when they need epinephrine
and to rush to the hospital and when they don't?
You know, you mentioned two different reactions,
but expound on that a little bit. Sure, so what
I teach my patients all the time is when two
or more systems are involved or anything life
-threatening You're gonna want epinephrine epinephrine
first and ready and the reason for it is I tell
them it's better to be safe rather than sorry
You won't hurt anyone by giving them epinephrine.
It's basically adrenaline and help stops an allergic
reaction in seconds to minutes And what you're
looking for is a fast response, because a lot
of people sometimes are scared to do an epinephrine
device. And they're like, well, maybe I'll just
take a little Benadryl. Maybe I'll just take
a little Zyrtec. It'll pass. But you don't want
to take the risk when it's an anaphylactic reaction.
So any symptom that's life threatening, throat
closing, shortness of breath, wheezing, feeling
like you're about to faint. or two or more systems
involve skin and eyes, skin and GI, so vomiting,
skin and lungs, any two combinations or one life
-threatening, you're going to give epinephrine
right away and call 911 to make sure the allergic
reaction has completely stopped and is resolved.
So even if you get epinephrine and we're talking
an EpiPen or a nephi, anytime that you give that
Does that mean you need a trip to the hospital
or a 911 call or is that enough for some people?
Sometimes it's enough, but when it's a first
time reaction, you want to make sure to call
911 when it's someone who maybe has had an allergic
reaction before and they're using the epinephrine
and they know when their symptoms are resolved,
then they might be more at ease with, you know,
calling their doctor, and then being monitored
by their doctor via phone and making sure the
allergic reaction has completely stopped. We
always carry our epinephrine devices, whether
it's Nephi or an EpiPen, in a two -pack. And
the reason for it is because if within five minutes
we do not get resolution of symptoms, you use
the second actual device. So if the first nephi
is not completely resolving the symptoms, then
you're going to use the second nephi into the
nostril and go ahead and repeat the dose. Same
with the nepinephrine pen as well, too, to make
sure the allergic reaction is resolving. All
right. Let's talk a little bit more about bee
allergies. One of the things that I've read multiple
times, and tell me if you know anything about
this, is that beekeepers who do not have any
kind of an allergic reaction to bee venom can
develop that later in life or whenever. How does
that work and why does that happen? Well, when
we have looked at studies that have looked at
beekeepers, what would account for desensitization
in terms of stakes. So if a bee stinging me,
how many stings do I have to get in a year for
me to be desensitized to be like, oh, I'm not
going to react at all. 200 bee stings will keep
you desensitized, desensitized and tolerant.
But most beekeepers do not get 200 bee stings
they got. So most beekeepers get about 25 bee
stings, but 25 bee stings actually do not create
a desensitization. They can create a sensitization.
So at one point or another, our bodies can decide
that they are allergic to B -venom when they've
never been allergic before. It's that one thing
that suddenly comes, changes our immune system
and can occur. And what basically then puts anyone
at risk who is a beekeeper for anaphylaxis. When
we look at rate of anaphylaxis in beekeeper,
it ranges from 15 to 47 % in beekeepers depending
on probably how big their hive is, how many stings
they get a year, et cetera. When I hear things
like that, my recommendation on our podcast is,
and always has been, every beekeeper should have
some kind of epinephrine, whether it's an auto
injector, EpiPen's the one we've all heard of,
Nephi, which I know you're very familiar with
and we'll talk more specifically about the difference
in a few minutes. Everybody should have one because
as a beekeeper, oh I'm not allergic, I can develop
an allergic reaction. Also, I have Kids that
come around and want to see the bees. I have
grandkids that want to be involved. I have neighbors.
Some people teach classes. Some people do agritourism
things where people come in and they have a beekeeping
experience. Especially if you're doing a lot
of that. Please just be safe. Cover yourself
legally and just be safe and be prepared for
something like this. Have it on hand and know
how to use it. Amen to that. Amen to that. I
couldn't agree more. Every beekeeper should have
epinephrine on hand for themselves and also for
any little visitors as well too. So in both doses,
the pediatric dose and the adult dose as well
too. So that way we make sure that everyone is
covered. We don't know when an allergic reaction
can occur and we want to make sure that we save
lives. We know that we lose 72 people a year
to bee sting allergy. and anaphylaxis, so we
want to make sure that we save as many legs as
possible. Yeah, that's just way too many when
there is something that we can do about it. Another
thing along those lines that I've read a lot
about is that families of beekeepers, even if
they're not involved in the bees, have a higher
percentage of them end up developing some kind
of allergic reactions. Are you familiar with
that? Yes, and part of the reason why that occurs
is because even though they're not the primary
beekeeper They're still in contact with the bees
and they go in and get the honey, etc So it puts
them at higher risk. They might be lower risk
for as many stings as the beekeeper But they're
still at risk which might actually put them That's
why they're at rest for anaphylaxis because they're
still have exposure to the honeybee venom Yeah
and it can even be on your clothes of a beekeeper.
Like your beekeeping jacket and veil. Some bees
will be trying to sting you from the outside.
That then may come into the house to be put in
with the laundry or something. And my understanding
is even if you're not being stung that is a type
of exposure to some of that bee venom. Are those
things correct that I've been reading? You are
correct, 100 % correct when it comes to that.
Yes, we don't have to be exactly stung, but yes,
we can also be exposed through just contact as
well. If someone does not have one of these devices
already, something of epinephrine, do we have
to go to our doctor and get a prescription? And
if we don't have an allergy, is our doctor going
to give us a prescription? Well, I think just
by vocation of being a beekeeper. I think most
doctors would definitely write for an epinephrine
device being an EpiPen or an Nefi device as well,
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enter code MLBLove10 at checkout. That's manlakeltd
.com. Discount code MLBLove10. Nephi has a program
though on their website that if you for example
want to get access to a Nephi you can actually
go on Nephi .com and be connected with a doctor
there who will be able to write your prescription
as well too if needed for both the pediatric
and adult dose given that you're a beekeeper
as well too. Give us an idea of what they cost
and how often we have to replace them because
I know they don't last forever. No, so when we're
talking Epi pens Epi pens are basically one -year
usual shelf like and you have to check the date
because sometimes They take them right off the
shelf and they might be expiring soon. So that
I always tell people check the date You're looking
at a cost depending on what state you live in
probably like $300 when it comes for a two -pack
and most people require Two two packs, right?
So that way you're gonna have an adult and a
child dosage as well, too. When we're talking
nephi, it's basically a shelf life of two and
a half to three years. Right now, the company
has negotiated. So even if it's commercial actual
pay insurance, then it's one hundred and ninety
nine dollars max for a two pack for the nephi.
What I like about nephi as well, too, is one,
it's ease of administration. Right. So you just
go right into the nostril. Because as an allergist
and immunologist, I have found that a lot of
people with the nephrine injection, they are
afraid of the needle. So they hesitate upon giving
it to themselves or to others. And that's really
scary because it's seconds or minutes that are
worth gold, right? You need to act fast. And
so Nephi, I have found, makes a lot of my patients
less anxious and have more relief. The other
thing I like is the temperature also that extremes
of temperature that it can have. With EpiPen,
one of the things that they have to watch out
is for the temperature extremes because you can't
leave it in a hot car because then it won't work
or in freezing temperatures. With Nephi, it goes
up to 145 degrees Fahrenheit that it can reach
and then the lower portion it can actually freeze
and if you thaw it within 20 minutes should beautifully
still work. So just so people know kind of the
differences between both. As soon as Nuffy came
out, I'll tell the story. I had all these moms
with college students who have food allergies
going, Dr. Mora, you gotta write the Nuffy for
my kid because there's no way my kid's gonna
carry a big EpiPen to the bar where there's peanuts
right on the table. And I wrote so many at that
point, but I realized what they were saying.
They wanted a little bit of peace for themselves
and peace for their child, but yet be well protected
with the device that they could use. And I found
you through the Nephi people and I do not, we
need to be careful. This is not an infomercial
today. Okay. We're talking about safety for everybody.
And I don't care which device you pick, just
have it on hand. know how to use it. To me, again,
personally, not an advertisement, Nephi makes
sense because you don't have a needle. Okay,
let's talk about this. How do you use an EpiPen
or one of the other auto injector brands? So
one of the things is when we use an EpiPen, and
I actually have a demo here, I'm in the office.
Are you going to actually stab yourself and do
it right now? That was so well, this is an actual
just it doesn't have any real medication or real
needle So it's just a practice demo So the way
I always taught people to use it is you would
grab it in a nice fist because you don't want
to poke your fingers with it Blue to the sky
orange to the thigh. It doesn't matter if people
are wearing jeans or anything They're wearing
you take the blue cap off and then you're going
to stab right at the thigh I'm gonna pretend
this is my thigh You're gonna stab and hold for
three seconds a thousand one a thousand two a
thousand three and then it's got a needle guard
So you don't poke your fingers with it as it
comes out So I had a lot of parents who at that
point are really nervous So instead they did
it upside down and they poke their fingers and
turn them blue. No No, no Yes, I've had a lot
of incidences like that Okay. And this is real
life. So this is why I tell these stories. So
obviously this is I practice with every parent
or every patient in this in the exam rooms, because
I want to make sure that they're able to use
it. And now I'll show you the nephew and a beekeeper
who just has this on hand, probably hasn't practiced,
maybe didn't get this little training from their
doctor. So I appreciate you filling that in.
OK, show us the nephew. How does it work? So
the nephi is in the same type of device that
narcanis So people will be more familiar with
it because it's obviously what it is It's you're
gonna press an actual tab right in the middle
They're gonna go right into the nostril and they
basically just have them relax there. I usually
have people count to five So a thousand one a
thousand two a thousand three a thousand four
a thousand five And then it completely starts
acting. I've used both of them on kids and adults,
and I know they work really, really fast. And
obviously in a life -threatening event, you're
going to want to use one of these devices immediately.
So with the nasal spray, the Neffe, do they have
to like, you know, breathe in, sniff in hard
or anything like that? No, that's the beauty
of it that you don't have to it just starts acting
completely. It goes in right into the sinuses,
goes right into the actual throat, goes to the
lungs, into the bloodstream, into the rest of
the organs, the heart, the lungs, the brain,
etc. So that way it starts completely shutting
down the allergic reaction. which is exactly
what we want. Intramuscular does the same thing,
but it just acts through the muscle, goes into
the bloodstream, et cetera, to hit the other
organs. And whoever you jab it in may punch you
in the face when you do it. What is epinephrine?
Tell us a little bit more about it. Epinephrine
is basically adrenaline. And since you have a
fun podcast, I always tell this story for patients
luck. we're talking about epinephrine and adrenaline
as it shuts down to receptors that cause allergic
reactions. I said you're not supposed to use
it like in Pulp Fiction where they put it right
through the heart. I said for the epipen to the
muscle for the nephi to the nose and I said it
just within seconds to minutes starts completely
acting. at the alpha and beta receptors. So these
are your adrenergic receptors in your cells that
start shutting down the cascade and the allergic
actual reaction that can occur. Okay, let's talk
about some other B -related allergies that I
know very little about. For example, are there
some people that are allergic to honey? There
are, but it's less cases of actual allergy to
honey, more actual cases of, say, botulism from
honey that occur in the actual public than actual
true honey allergy. That was my next question.
Why don't we feed honey to babies under the age
of one? And such a beautiful and wonderful question.
And that is definitely cases of botulism that
used to occur. We are seeing currently, and this
is I'm glad we're bringing it in on your podcast
as well, too. Secondary to a baby formula, now
there's four cases that have occurred secondary
to a botulism, secondary to this actual infant
formula that can occur. So this is why it's so
important that we also keep honey out of baby's
diets during the first year. Okay, how about
other B -related products or what we call hive
-related products? For example, propolis and
royal jelly and things like this that people
are often using in a quasi -medical sense or
a health sense. What do you know about those?
As a lapina doctor, I know a lot of the home
run that he's involved in. And obviously we all
know, for example, honey in your tea, right?
For that sore throat that actually occurs every
single year for the flu, et cetera. We also know
the medicinal properties of honey that can have,
right? So one is that's a beautiful one. The
soothing of the throat when you're sick, decreasing
of the mucus that actually occurs with honey.
But then there's other. and things that honey's
used for. So a lot of people also who might have
bad environmental allergies feed it to their
kids as well too. And they say, well, it's gonna
help them to develop some sensitization so that
way they're less allergic to the environment
as well too. So using it as a medicinal property.
doesn't have much data when it comes to it but
I never deter people from doing it because honey
obviously is something good for you as well too.
So honestly I love the mix of western and a little
bit of eastern medicine and I think it brings
a lot to the table. That's actually why I got
into beekeeping in the first place. I have pretty
major seasonal allergies to you know tree pollen
and grasses and all kinds of things and so I
had read a whole bunch of stuff about eat raw
honey and they'll go away. Well it's obviously
not anywhere near that simple but here's what
I did and again this is not research this is
just one person's experience. I bought honey
from raw honey from a beekeeper about 150 miles
away from where I live and religiously had like
a spoonful of this every day for a few months.
Allergy season came along It did nothing. It
didn't help me at all. As I did a little bit
more of my own research, what I read was how
important the hyper locality of everything is.
If the bees are foraging right around where I
live. I may get more of that pollen that then
is going to desensitize my allergies some. And
that is exactly what happens. That's why I got
into beekeeping. I eat my own raw honey and the
allergies are not gone. But literally, Dr. Mora,
they're like 50 percent better, which to me is
a big deal. That's beautiful. Absolutely. So
it worked somewhat for you, which is great. And
that's why, like, I don't take it away from people.
I think it's a wonderful mix. Like, we can do
the raw honey. We can do the antihistamines.
It all works. Yeah, but I'd rather not have to
take so much antihistamines. Yeah, I know. Okay,
last thing. And you don't have any of your own
beekeeping experience, do you? No, I wish I did.
My grandfather did in Mexico back when I was
a little girl. We can get you set up even in
Chicago. Oh, I love it. I would love it. Every
guest that comes on the show, and 99 % of them
are beekeepers, I give them an opportunity to
talk about a wild and crazy beekeeping story.
Something that is funny or just crazy or painful
or embarrassing. As an allergist, an allergy
doctor, I'm going to give you the same opportunity.
If you're allowed to, you don't have to use any
names or anything. What kinds of crazy Allergic
reaction and things with patients do you run
into? Well, I think I'm going to speak from the
experience of my grandfather because I was a
six year old little girl. I visit him in Mexico.
He had a beehive. He loved his bees, et cetera.
And I was a very, you know, I would run around
a lot and just not a sit down little girl. I
sat down on a beehive. And I got probably about
a hundred things Now, you know what makes this
funny is look who got actually stunned so much
Completely had to get antihistamines etc and
then became an allergist Just as a little bit
of practical advice for anybody out there beekeeper
or not when they get stung by a bee Are there
any recommendations? I mean I've heard Benadryl.
I've heard ice. I've heard other things. What
would you recommend? So I always tell my patients,
especially those that get on a big allergic reaction,
is making sure that they do, for example, they
can double up their antihistamine on the day
they're going to be outdoors, right? So if they're
going to go to that picnic or the kids aren't
at camp or they're going to go see their grandpa
who's a beekeeper, etc. This might be a good
time to basically help to decrease any local
reactions by doubling up their antihistamines
for the day. I like ice on the actual sting when
it occurs and then a little bit of hydrocortisone
cream, which basically helps to decrease the
reaction and doing a dose of antihistamine if
they haven't had one. We're kind of yielding
away a little bit from Benadryl as a short -acting
because of the side effects, sleepiness, etc.
So then I tell adults or kids to do a dose of
Zyrtec or Zyzo or Allegra or anything that's
a little bit long -lasting to kind of help to
decrease the reaction. OK, I appreciate that.
Is there any other wisdom you want to share with
us before we let you go? Well, I definitely want
to make sure that, you know, beekeepers, I obviously
respect all the work, wonderful work that you
do for our country, but I want you to keep safe.
Please have an epinephrine device. at your workplace,
have pediatric dose, have an adult dose as well
to get it from your doctor, very important, could
save your own life. And your life is priceless.
So I always say, do it, get it. The other thing
is making sure that you use it in case of a severe
allergic reaction or any two systems involved.
Don't hesitate. You'll never be wrong for using
it because it's better to be safe rather than
sorry. Then the third thing, continue the protective
gear because it's so important as well too. And
continue to educate as well to other beekeepers
and keep a podcast like this one, which is amazing,
that helps to keep everyone safe because at the
end of the day, I love working. towards public
health in terms of making sure that we save as
many lives as possible. And we're trying. I'm
so happy that Nephi's out on the market because
it's about saving lives. We don't want those
72 lives lost every single year due to bee sting
allergy. We need to save more people. And having
an epinephrine device at hand will do that. Thank
you, Dr. Mora. I appreciate you being with me.
Oh, you're welcome. Have a beautiful day, everyone.
Thanks again for joining us on Be Love, Be Keeping
presented by Manlike. Another big thank you goes
to V2B Health for their support. Vita's Varroa
Control Ranger products includes Epistan, Epigard,
and now Varroxan Extended Release Oxalic Acids
Trips. Hey thanks a lot guys. And if you haven't
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remember if you're not just in it for the honey
or the money, you're in it for the love. See
you next week.