Bites and stings

RE: Bites and stings

niall morton — Wed, 01 Jun 2016 20:55:30 GMT

surely getting hot/swollen and itchy are all the symptoms a dex injection helps to limit? especially the itching which can lead to a self trauma injury.

RE: Bites and stings

Clover — Wed, 01 Jun 2016 11:49:53 GMT

[quote user="Bob Russell"]

Get a better bee suit or re-queen with a calmer variety! Ours are pretty gentle and came out to investigate when I cut the grass round the hives but nothing more!

[/quote]

My feisty hive is my best producer! (I say routinely - three so far this year so not all the time)

RE: Bites and stings

Bob Russell — Wed, 01 Jun 2016 10:27:09 GMT

[quote user="Clover"]

I keep bees and routinely get stung. It gets hot and swollen for 24-48 hours then itches like nothing else for a day or two then it's done. Normal reaction - gradually getting less over time. But don't take anything for it as find piriton does naff all anyway

anaphylaxis happens rather quickly and you'd know as the animal would be rather poorly. A one off dex might help speed things up but otherwise sure for owner benefit

[/quote]

Get a better bee suit or re-queen with a calmer variety! Ours are pretty gentle and came out to investigate when I cut the grass round the hives but nothing more!

It is wasps that I hate especially in August when they are a pain in the backside.

RE: Bites and stings

Elliot Kneba — Wed, 01 Jun 2016 09:58:31 GMT

If clients are concerned about cost then just give the meds PO - no tremendous difference in onset and efficacy in a non-emergency.

RE: Bites and stings

Martin Atkinson — Wed, 01 Jun 2016 08:57:30 GMT

[quote user="Clover"]I keep bees and routinely get stung. It gets hot and swollen for 24-48 hours then itches like nothing else for a day or two then it's done.[/quote]My father kept bees and I was regularly stung but had virtually no reaction. Ditto, wasp stings - apart from one that once laid a trap inside my slipper and stung me on my foot!

[quote user="Clover"]A one off dex might help speed things up but otherwise sure for owner benefit [/quote]Are we sure its not for the vet's benefit to justify the fee? Chlorpheniramine injection costs a lot more so you'll make a bigger profit!

RE: Bites and stings

Clover — Wed, 01 Jun 2016 01:28:16 GMT

anaphylaxis happens rather quickly and you'd know as the animal would be rather poorly. A one off dex might help speed things up but otherwise sure for owner benefit

RE: Bites and stings

Elliot Kneba — Tue, 31 May 2016 17:30:01 GMT

I usually have the owner pick up a pack of Piriton to give in 8-12 hours if the first round wasn't enough.

RE: Bites and stings

Bob Russell — Tue, 31 May 2016 17:18:48 GMT

Generally the concern is with preventing delayed reactions. How many patients that have been stung are in real trouble when they arrive at the door? Not many in my experience.

I have never seen a single dex injection cause any GI issues but should I see one, it may lead me to change treatment.

It is considered a possibility that bee stings in humans might be more severe with steroids in the system but I am unclear how they worked this one out!

I know this is a situation where evidence based treatment would be nice but dogs are not people and it is not necessarily safe to transpose reactions and findings between species.

RE: Bites and stings

Elliot Kneba — Tue, 31 May 2016 17:04:18 GMT

Animals with non-life threatening allergic reactions to bites and stings get an anti-histamine from me. Dexamethasone's peak activity kicks in at around 4-6 hours and may help with delayed reactions, but the downside is that if the reaction becomes more severe you have steroids in the system with a risk for potential GI issues like ulceration. All seem to respond rapidly to chlorphenamine IM.

Any animal with true anaphylaxis gets adrenaline either as a bolus or CRI and appropriate fluid resuscitation.

RE: Bites and stings

Martin Atkinson — Tue, 31 May 2016 14:17:41 GMT

[quote user="K Burton"]An anti-histamine isn't going to reduce the effects of histamine that's already been released[/quote]Given you can almost see the urticaria disappearing before your very eyes suggests it is working! Of course it could be a placebo effect as most go down by themselves anyway.

Unless there is going to be a serious, ongoing, health threatening inflammation which there is never IME from a sting or bite (unless its an adder in the UK) and that all residual inflammation has resolved in 24 hours with an anti-histamine/on its own, corticosteroids are still contraindicated.

RE: Bites and stings

Kathryn Burton — Tue, 31 May 2016 11:57:15 GMT

I give corticosteroid on the basis that histamine release --> inflammation, corticosteroid reduces inflammation. An anti-histamine isn't going to reduce the effects of histamine that's already been released; maybe it reduces further histamine release and development of further symptoms though? My understanding is that anti-histamines are better taken (in humans at least) before exposure to the allergen actually happens.

RE: Bites and stings

Martin Atkinson — Tue, 31 May 2016 11:26:53 GMT

There is no logic in giving corticosteroids for an acute histamine release allergic reaction to a sting/bite. The important word here is histamine so you give an anti-histamine - get it?

Now whether you think it is worth giving an antihistamine and which you choose is another debate but corticosteroids are not indicated, they are only effective in less acute cellular based allergic processes.

RE: Bites and stings

Bob Russell — Tue, 31 May 2016 09:27:44 GMT

I don't bother with antihistamines. If there is a marked reaction then I would give dex. Never seen a severe enough reaction for i/v use but would be happy to use it if necessary. Adrenaline should there be airway/resp issues.

I don't find patients to be itchy in the way humans often are.

Piriton for placebo use by owner for minor stings.

Humans with 'normal' reactions to stings, remove sting (edge of credit card recommended on our bee keeping course!), ice packs and paracetamol or ibuprofen for pain. Clearly dogs don't get the later!

RE: Bites and stings

Aine Seavers — Tue, 31 May 2016 08:24:31 GMT

We don't have lyme's here -allegedly -so no and even if did I would not give post tick bite as a routine as a full course of antibiotics is as not the same as a once off dose of antihistamine-plus I dont use Piriton at all. Here the ticks will either give the person an anaphylactic response or nothing or leave you with a cross reaction when eating beef- an increasing life threating issue in some parts of Sydney. The dog would most likely get tick paralysis if Ixodes needing antiserum not antibiotics unless already at the aspiration pneumonia stage., 3 other types of tick tend not to be a drama. The spiders are not the problem here for allergic reactions, pain and vomiting yes but the dogs not so vulnerable as the humans -where if one reacts it is a venonous response-but we have horrendous ants and other biting insects-and often the inciting creature not identified esp in the surf or with ingested seafoods poisoning where anti-histamines will save a patient when heavy duty other medications will not.

RE: Bites and stings

Neil Wheadon — Tue, 31 May 2016 08:08:57 GMT

OK we're in the UK so no spiders here, but when was the last time a dog with hives died? The geographical argument can't really be used in the UK either.

How do you know piriton does no harm, any drug is a systemic poison. (OK I'm overplaying the point but....)

I simply don't buy the pain thing having been hospitalised myself after a horse fly bite and having to sit in a glacial river post wasp bite, it's transient. Trying to compare this to a bitch spay is a little fanciful.

The core here is unecessary medication especially when the vast majority don't need it. Are you abvocating Doxycycline for any case of ticks removed from a dog after 24 hours, just in case they get Lymes disease? (Now I'm getting fanciful, but maybe I've listened to to much BREXIT arguement )

Neil

RE: Bites and stings

Aine Seavers — Tue, 31 May 2016 01:08:13 GMT

it may also do with location, 5mins from the vet where it can be rechecked so no need to have a supply at home- many clients will tell you that the urticaria etc will reappear just not as intense- so your no meds just ph call 24hrs later might work- but where your patient is unable to access a recheck easily-be it a long time b/n 2 trees as they say here in Oz or simply no way to get the patient back easily oohs-then giving a 24hr supply of an anti-histamine obeys the rule of first do no harm and can positively impact on the ones who it does benefit. Not dying over night so the owner can tell the 24hr later phoning vet that all is ok is not the reason why its given-its is we effectively provided relief where we could from the on going effects of the reaction. There was a time when no analgesia was given to spays because they were 'fine'in 24hrs -we have moved on from that mind set and hence why I give the anti-histamine as being 'fine'24hrs later is not all its about.

RE: Bites and stings

Neil Wheadon — Mon, 30 May 2016 15:52:29 GMT

Hi Aine

My post didn't say there was no effect, what it inferred was that clients call vets with animals that they have given anti-histamines to with no effect.

This backs up my observation having asked a lot of people with allergic dogs who have tried anti-histamines if they had any effect. A few say yes, but many say no and I have asked lots of people. (I ask owners a lot about treatments, and see a lot of different ways of working as I locum, because I find it interesting)

The point of the post was asking if we should be following up with anti histamines. My reply and nothing so far has changed me is 'what's the point?' To blanket treat every case with antihistamines just in case there are the few that respond. Better surely to ask the client to call back within 24 hours to see how things are going which is why I'm pretty confident about my orriginal posting. Now that's evidence based.

Neil

RE: Bites and stings

Aine Seavers — Mon, 30 May 2016 13:03:44 GMT

it depends on the antihistamine and the formulation- i have found zero effect from some tablet formulations and yet liquid version effective.Having seen my own dogs stung by bees and being miserable for hours until we got the antihistamine in them-and adding my own experiences-in the canine non epileptic, good renal function and non glaucoma risk patients-they do help. Here we have licencedveteriinary anti-histamine injections and an oral veterinary antihistamine -iramine -so not sure where the 'no effect in dogs anti antihistamine'approach is based on with your reply -let alone the work in g.pigs on antihistamines and in cats as a co-adjunct in feline asthma-so yes in this instance i am comparing histamine release and distress in humans to animals and finding both scientific and personal experiences to match.

RE: Bites and stings

Neil Wheadon — Mon, 30 May 2016 10:24:32 GMT

You're comparing people to animals?

In people they work. In animals for me the jury is out on these. I've seen lots of animals who have already had piriton to no effect.

Neil

RE: Bites and stings

Aine Seavers — Mon, 30 May 2016 01:06:06 GMT

most of the ones who come to the vet are by default severe but also having been stung again in adulthood on the foot(in the surf of all places!) by a bee- I didn't get an allergic reaction but boy did it hurt for 24hrs and it was annoyingly focal itchy for almost a week-I wonder how many of these pets go home and just stoically put up with the discomfort but given the Triple As of analgesic consideration then one could reasonably anticipate that the distress will be not excruciating or life threatening any more but still present to a degree we could alleviate.

I do as you do send them home with a house pack put also a travel pack to have in their bag/pocket when going for walk or trip for further episodes due to how remote some of the areas are that clients here can take their dogs on walks.

RE: Bites and stings

Utlendigur — Sun, 29 May 2016 14:34:20 GMT

[quote user="Aine Seavers"]I always used the antihistamine on first presentation [/quote]

So do I, but I don't tend to send them home with anti-histamines unless really severe. If the dog is known to react to something on a regular basis I will send them home with some to keep in reserve so they can dose the dog asap after contact with whatever sets it off

RE: Bites and stings

Aine Seavers — Sun, 29 May 2016 06:47:15 GMT

Are you using i/v dexason or the s/c i/m dexafort?

I always used the antihistamine on first presentation as well due to a 2hr delay before peak with the Dexason and I do send them home with oral liquid phenergan for the next 24hrs as the allergic life threatening response gone but there is some residual itch and maybe pain left- if you talk to owners and human allergy folks-for the next 24hrs so given some antihistamines analgesic as well then for the non -epileptic patient it will do no harm. I also have them give a warm tepid soothing shampoo bath in case it was a contact reaction remaining on the skin if the inciting cause not known

RE: Bites and stings

Neil Wheadon — Sat, 28 May 2016 10:14:40 GMT

[quote user="K Burton"]Is there any evidence base for following this up with an oral course of chlorphenamine? If the allergy has already happened and the inciting cause is gone is there any merit in providing an off licence anti-histamine? I seem to be the only vet who doesn't routinely do this, so concerned I'm missing something![/quote]

The evidence base for me is that in 25 years I don't give Piriton after a dex injection and have had follow up in nearly all cases. A handful reported that after 24 there was still slight irritation/hives but nothing alarming. That's good enough for me

Neil

RE: Bites and stings

Lucy Fleming — Sat, 28 May 2016 10:10:08 GMT

I usually send them home with some Piriton - not to follow up with a course, but so the owners have some at home to administer in the case of future bites/ stings