VIT Report: Allergic to Beestings – Not Anymore!

Well, that was anticlimactic. There wasn't any blood test, just the question, "Do you want to stop?" The allergist was satisfied by my 'time served' and successful field test in 2017. And just like that, I'm done. Okay to stop venom.

An anaphylaxis kit should include Epinephrine, Benadryl (an H₁ antagonist) and Tagamet or Pepcid (H₂ antagonists).

Here's the damage:
Time Served: 6 years (6 months of twice weekly or weekly shots, 4 1/2 years of monthly shots, 1 year of monthly-ish shots)
Shots Taken: 220
Office Visits: 160
Miles Driven: 1,500
Out-of-Pocket: $6,500 (not including gas)

These are just approximate figures because my Excel file got vaporized. The exact numbers don't really matter, though. My point is, VIT is a commitment. You must be committed to adhere to a regular schedule, committed to spend a bunch of money, and committed to stay in it for the long haul. With the commitment comes a payoff. It works! Well, it does for 85% us.

What were the final Things I Learned About VIT?
• VIT works for 85% of people with allergy to bee sting.
• Those in the 85% are sittin' pretty for 2 years.
• After 2 years, the likelihood of a systemic reaction is 10% per sting.

So if 3 years from now I get stung twice, there's an 80% chance I'll be fine, 20% chance I'll have a severe reaction. I must always carry epinephrine autoinjectors. I'm glad the retail price of Epi-pens has come back down but $124 (or $110 for Adrenaclick) is still quite a hefty price tag.

As for keeping bees again, it's still the plan but not here in Colorado unless a bunch of bees just happen to move into my empty hives. 😉🤞🙏 Meanwhile, I need to connect with Marty. I've been working on editing and updating his booklet "The Appropriate Beehive"… for 2 years! It won't be drastically different, so go ahead and download the current PDF for free today.

How does desensitization work?

I keep wondering, why does getting stung by a bee cause an allergy but getting allergy shots fix the allergy? An injection contains venom the same as a sting, so why is the outcome different? In my never-ending quest to understand how sensitization/desensitization works, I found this incredibly educational article, written by a doctor who is also a Master Beekeeper. I need to reread them but I think the answer is in these articles.

Posted with permission of Buddy Marterre, MD.

Bee Stings: Immunology, Allergy and Treatment, a two part series of articles originally published in the American Bee Journal.

"Although it’s part of the business, few of us actually look forward to being stung. As beekeepers we need to know about the various reactions to bee stings and be responsible to ourselves, family, neighbors and friends in regard to bee stings. I hope this article will serve some of those purposes and be informative to both the beginner beekeeper and the most experienced scientist. The first part will cover insects that sting, honey bee stings in particular, bee venom biochemistry, precautions and sting prevention, the management of beekeeping emergencies, and basic immunology and allergy. The second part will cover sting reaction types and treatments, allergy testing and desensitization results, and specific recommendations for beekeepers." Click on the thumbnails to read the rest.

 

Dr. Marterre requests that you not download his articles without his express written permission. Contact me for his email address.

How to make $100 blogging about bees + Backing Up a Bee

BLUF: Use Blogger Sure you can set up a visually beautiful SquareSpace or Tumblr, but when it comes to long format blogging, WordPress and Blogger rule. Both provide free blogging but only Blogger lets you monetize your blog gratis.

Not only that, with WordPress.com (which is very different from WordPress.org), you have to pay a $30 premium annually to run an ad-free blog. One reason to pay the premium is that you have no control over the ads that run, and some of them will go against your principles. The blog I run on WP is for people with MdDS, which most often rears its ugly head after a cruise, and WP kept running cruise line ads because its algorithm understands keywords not meaning.

By default, Blogger does not run ads on your blog, no upcharge involved. It's one of the reasons they've had my loyalty since 2008. Another reason to love Blogger is that through the power of AdSense, also a Google product, when you let ads run you earn money! You control the size and type of ads that runs, where they appear on your blog, and even do some blacklisting. I don't let pesticide or exterminator ads run on my site, for example. Mostly you only earn pennies per ad, sometimes just one, but if you consistently write quality content and your blog sees regular traffic, the pennies add up. When they add up to $100, Google sends your first payment.

I think I have two readers so it took me 9 years to earn it, but my check is in the mail! Don and Julie, sorry about serving up ads to you. To make it up, for an ad-free future I highly recommend the AdBlock extension. It's free but I like it so much I have donated to them, while working in the advertising industry.

Nine years of blogging and 357 posts. That works out to $11.11/year or $3.57 per post. Unfortunately, considering the investment I've made over the years to provide the consistent, quality content mentioned earlier, in reality I'm quadruple digits in the red. The things we do for our bees, right?

Speaking of, here is the long promised video of Marty Hardison administering a live bee sting so that I can get back into the business of keeping bees. I recorded it in slow-motion for you but YouTube is serving it up in real-time. Sorry for that, and for it not being closer in. I was recording with my phone in my left hand and an ice cube in my right. I was able, however, to grab a still of the stinger being ripped out of the bee, which you can see over on IG.

For the record, I don't recommend taking a sting to the calf (or any muscle-y area), but I would not have been able to record a live sting to my bingo wing. The things we do for our readers, right?

I arrived at Marty's house confident that 4 years of allergy shots had lowered my venom sensitivity and indeed, initially, I had very little reaction. No pain, no itching, barely a welt. A few hours later I had a bit of a cankle. This is classic of a late phase reaction but this type of swelling is considered "large local" or in other words no systemic reaction. Yay! I'm so close to keeping bees again, I can taste it. And of course it tastes sweet.

I'm pretty sure the swelling was because a) not enough fatty tissue to delay the venom reaction, b) we stared at the stinger after it was autotomized for a few seconds, then c) we did the one thing you're supposed to not do, and that was squeeze the venom sack that was still in my leg so I got a big dose of venom. A honeybee sting normally delivers 0.05 ml (sometimes written 50 μl) of venom but the venom sac has a capacity of up to 0.1 ml.¹

Marty also put together some bees-to-go using queen cages but, well, I'll just say that what I did with them is a long story for another time. Combining my experience with VIT with how allergists are being advised to cope with the venom shortage, and the apparent fact that fresh venom is more potent than reconstituted venom, I'm going to wait two months between live stings.

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¹ Journal of Evidence Based Medicine and Healthcare, "A rare case of survival of honey bee sting victim with more than 1000 stings."

VIT Report: Build Phase #2 Complete

Next week, I will have gotten 45 injections and driven 111 miles. It's my last week of build, sort of.

Next week, I will receive the target amount of paper wasp and mixed vespid antigens and will be migrated from weekly shots to monthly shots. Honey bee? That's another matter.

Can you believe there is still a national venom shortage? The nurse told me that the there was a contamination problem and the supply had to be destroyed. Honey bee venom has been on backorder for a while and there is no ETA.

Going through build this second time around has been a cake walk. I'm confident enough that the therapy is working to take my VIT into my own hands and will be stopping by my mentor's house for a sting. Scheduling is TBD but he's headed out of town shortly, so hopefully soon.

Meanwhile, here's a queen spotting challenge from the 10th annual Parker Honey Festival for you.

Find the Queen!

A post shared by My brain runs on Bees. (@backyardbee) on Aug 5, 2017 at 9:40pm PDT

Q: I have been getting monthly allergy shots but have missed getting them for the last 4 months. Can I pick up where I left off?

Actually, I missed getting them for 9 months. I never went to Marty for in-the-field therapy because last I checked I was still highly sensitive to honeybee venom, and I didn't think it was fair to put him in a situation. He didn't care but I'm not that cavalier.

I can't believe it took me 9 months to work through the transition from employer-provided to marketplace to state-sponsored health insurance. During that time, I switched doctors. Colorado Allergy & Asthma Centers rarely had answers to my questions, and it was time to work with someone who did. My new allergist definitely does things differently. He actually listens and thinks. He even asked, "What's so fascinating about bees?"

Loaded question? You tell me! #bees #abejas #abeilles #μέλισσες #api #topbarhive

A post shared by My brain runs on Bees. (@backyardbee) on Apr 8, 2017 at 11:36am PDT

When it comes to anaphylaxis, a conservative approach is de rigeur. He ordered new labs to determine my level of IgG (protective) as well as IgE (allergic) antibodies. Kaiser Permanente kindly threw in a cholesterol check gratis, since they had me in the chair. While CAAC's findings only showed my level of sensitivity, the new test shows I also have some degree of protection at least to honey bee. Yes!* I'm tempted again to go to Marty for an in-the-field sting challenge — and find what would happen if I were actually stung by a honeybee — but now that I'm on Medicaid immunotherapy injections are just $2 for me, as are generic epinephrine auto-injectors! They do not come with a trainer, which are free by request. If your insurance only covers generic, be sure to get one as they work rather differently from Epi-Pens.

Anyway, the question was, "Can I pick up where I left off?" The answer is, "Yes and no." Because of the amount of time lapsed I must go through a full build phase but then I can resume maintenance shots where I left off, to complete the five years total (combined time on shots at CAAC and Kaiser).

Surprisingly, when I told the allergist about my mentor's willingness to administer in-the-field therapy, he said, "Do it in the parking lot of the ER." Maybe he's read this paper.

"A sting challenge with a single, live insect can be used in treated patients to identify those who are not protected.^[112] This should be performed in an emergency care setting approximately 6–18 months after the maintenance dose has been reached…" Source: "Hymenoptera Venom Immunotherapy," Beatrice M Bilò; Floriano Bonifazi, Immunotherapy. 2011;3(2):229-246.

So that's the VIT update, almost 4 years post-anaphylaxis to the day. I'll be writing a post on my experience at Kaiser-Permanente when I'm close to reaching maintenance again, and if possible will include information on "How much does Venom Immunotherapy cost?".

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*There is some controversy as to the usefulness of measuring IgG antibodies. Some studies have found it to be useful and others have not.
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2222.1983.tb02592.x/abstract
http://www.aaaai.org/ask-the-expert/venom-immunotherapy-beekeeper
http://www.aaaai.org/ask-the-expert/igg-honey-bee

Affordable Epinephrine. Affordable Healthcare.

Interviewing for a job these days is interesting. Instead of action words and bullet points, my new resumé features Honey Glow and prominently displays my social "handles" complete with icons. On the emailed version they are clickable. My first interview went something like this.

UNKNOWN CALLER: "Hello? this is [garbled static] at Sur la Table. I'm looking at your bees. I love honey! When are you going to be finished with getting shots?"

ME: Whoa! I think to myself. Okay, interview mode… That's kinda a weird question. What's the right answer? Something positive but not too detailed. What are they looking at…my Etsy shop? Instagram? Blog? Don't hesitate too long, say something!

UNKNOWN CALLER IS WAITING

ME: "Two more years but I'm thinking of starting again in the spring. I have to carry EpiPens any way, so why wait," I answer optimistically.

Well, the $300-600 per pair cost might have something to do with that. Except, maybe not! At least two groups are working to provide alternative delivery devices. Allergy Stop's got a couple of things going for it that make it a better choice than Mylan's product: it's small and it's going to be affordable. Like 50 bucks, if the doctor that's developing it can raise the financial backing needed to bring it to market. I'm assuming the cost can be so low because the mechanism is pretty basic; you'll get a preloaded syringe but will have to attach a needle to use it. The outer packaging looks pretty sleek.

Learn about Allergy Stop at 

allergystopnow.com.

Learn more about Windgap's device
at youtu.be/4bUQ2Qywtn4.
Photo from marketingmama.com

Windgap Medical is working on another fits-in-your-palm sized device but it's still 2 years from even submitting an application to regulators. Their auto-injector will employ a wet-dry mechanism, which is supposed to make their product more temperature-stable than EpiPens. I'm interested to know what its extended shelf-life will be. It probably won't be as affordable as AllergyStop, but a potential 5-yr shelf life sounds pretty good, and it will have the portability factor that is so important.

I've written before about the form factor of Epi-Pen and AdrenaClick. Unlike the $300 generic EpiPen or $200 generic AdrenaClick, these novel devices are something I can look forward to. I don't care that AllergyStop isn't autoinject, or at least I don't think so. My allergic reaction isn't as quick as for others that suffer anaphylaxis. (Knock on wood.) What matters, to me, is that I'll be able to afford it and once I have it I won't ever choose to not pack it because it's too bulky.

40% employee discount? #yesplease . . . #cheflife #milehighdreams

A photo posted by @backyardbee on Oct 18, 2016 at 11:31am PDT

And now for the second half of the post: Affordable Healthcare. I'd really like to know who the moron is that determined that laying out 9.66% of your HH income for premiums is affordable. Like many Americans, I'm finding the best way to make healthcare affordable is to not have a job (or earn no more than $11,970) and then take the subsidy. It bothers me that the system is designed to encourage Americans to not contribute to our economy. And on top of that, to take from it.

Poverty is pretty easy to achieve, so I'm officially on Medicaid now. Unfortunately, there's still some hinky data in the system preventing me from selecting an actual health insurance plan. Once I do, you can rest assured I'll be getting back on track with the VIT. Should be interesting…I have a pretty strong feeling a build-up phase will be involved.

Calling all Beekeepers. Be #ChangeMakers. Sign the petition to make EpiPens affordable for everyone.

My #anaphylaxis kit includes a set of EpiPens. 💸💰💵 If one more person suggests getting the coupon from #EpiPen, I'm going to scream. I am 💯% sure that I am just one of millions whose $300/mo "#affordablehealthcare" has a high deductible and prescriptions aren't covered. The coupon is literally worth $0 if you don't have a copay to apply it to. Be #changemakers @walgreens @walmart @kpthrive @mylannews #heatherbresch and bring your prices down!

A photo posted by BBHB (@backyardbee) on Jul 29, 2016 at 12:47pm PDT

Sign the petition to make EpiPens affordable for everyone.
https://forcechange.com/159185/make-life-saving-epipens-affordable-for-everyone/

VIT Report: Allergy Blood Testing

Quick VIT Update: After 3 years of venom immunotherapy I insisted on a blood test to gauge my progress. Of course it was an exercise in you-have-to-educate-yourself-because-the-medical-professional-will-be-______ [insert unkind words]. While waiting for the results of my $195 RAST test to come in, I did some online research and this is what I learned.

Your body produces immunoglobulin E antibodies (IgE) in response to exposure to an allergen, and allergy blood testing reveals the level of IgE present. Desensitization, in theory, lowers your IgE level with each shot in the arm with a goal of being undetectable or nearly so. In the chart below, you can think of the Class Scoring as reaction potential, lower numbers being better. Note that I say potential, as reactions just are not predictable. A person could have <1 kU/L (see chart below) and still suffer a severe allergic reaction.

SOURCE: http://ltd.aruplab.com/Tests/Pub/0055105

Armed with this info, when the call came that I was still "very" sensitive to honey bee, I didn't feel like I needed to ask many questions. My actual test results were 16.2 for honey bee and "about a 1" for the other bees I'm allergic to. While my allergy to paper wasp, whitefaced hornet, yellowfaced hornet and yellow­jackets is moderate, the allergist is recommending (given my not-covered-by-insurance situation) that I continue with just honeybee VIT. And that I refill my Epi-Pen prescription ($615 today, according to GoodRx.com).

And the single-venom antigen cost? Self-pay cost is $250 (less 20% for paying in cash) for 10 doses. If you want to check with your insurance company, the CPT code for a single venom is 95145.

UPDATE: 24 AUG 2016
I initiated the switch to Kaiser-Permanente and discovered a) their allergy department handles immunotherapy completely different from Colorado Allergy and Asthma Centers, and b) I am economically better off sticking with CAAC.

CAAC makes antigen vials just for me. Every 6 months I pay for my own set of vials in the fridge that they draw from. I pay for each injection but there is no office visit fee. KP creates a "pool" of antigens that all their patients draw from, and those patients are not charged (currently was emphasized). However, each patient pays for their injections and office visits, which on my high-deductible plan is a high fee. It works out to $45 at CAAC versus $145 at KP per injection.

I need to investigate further something the KP allergist mentioned. He said, "Checking a baseline tryptase is something we do for almost all patients with a history of hymenoptera anaphylaxis. Patients with mastocytosis (the condition for which tryptase is a marker) are at risk of having reactions to bee stings and having worse systemic reactions to venom injections--so we just look for it to be thorough." Do you have any idea what that all means?

Marty Hardison on the Importance of Getting Stung

The video is actually titled, "Michael Palmer — Importance of Getting Stung" but he's not the first beekeeper to think that getting stung is important. This is what my mentor and his decades of beekeeping experience have taught him. Beekeepers and more often their non-beekeeping family members can develop a sensitivity to bee stings by inhaling bee proteins. Not exposed to the actual bee venom, their immune systems do not develop a tolerance to stings, but the protein is close enough to develop an allergy.

All that time I used to spend standing near my hives, breathing in the aroma — it's amazing — probably weren't good for me. In addition to my sting rate averaging less than one a year, my body was getting enough venom to activate my immune system but not enough to develop a tolerance.

Marty once found his wife unconscious and later his son developed an allergy. If I recall correctly, his son went through VIT like me but Marty administered live stings regularly afterward. We've talked about my allergy a few times, and now that my allergist isn't in-network Marty is going to teach me how to administer in-the-field venom therapy. He's going to "back up a bee" to administer a sting. Instead of having to grab a bee by its wings, Don from buddhaandthebees.net told me about using duct tape to snag a bee but I'm an experiential learner and really need to see it done firsthand to feel confident that I'm doing it right.

This month's injections are my last at the allergist, and then I need to be sting-free for 6-weeks before I can have my blood tested. If test results are A-OK, I'll have Marty show me as soon as he can after that.

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Michael Palmer says "t cells" in the video but he means g. IgG antibodies are protective antibodies, and IgE are allergic antibodies.

You might be interested in: https://en.wikipedia.org/wiki/Allergen_immunotherapy

I Wish Someone Would've Told Me BEFORE I Started Beekeeping… #6

My beekeeping addiction knows no bounds. Yesterday for 303 Day, I bought a GoDaddy domain name for this blog. See up top? You're looking at www.303beekeeper.com now. Why I spent $10 to have that URL is kind of beyond me, except that it gives me something to write about. I spent good money for blog content. It really makes no sense because, as I've said before, all beekeeping is local. If I move (and that is the plan) then I'm going to have to buy another domain with my new area code, like 805beekeeper.com.

For #303Day, I bought a URL for my #Blogger blog: 303beekeeper.com 🐝#303beekeeper #bees #beeblogger #beesofinstagram #abejas #Beekeeping #abeilles #beekeepers #yaybees #denver #CO #milehighcity

A photo posted by BBHB (@backyardbee) on Mar 3, 2016 at 9:14am PST

The thing I've spent the most money on, though, for the sake of giving you something to read as much as for my own safety, is Venom Immunotherapy (VIT). And this brings me to #GoodToKnow #6:

I wish I would've known BEFORE I spent $6,000 that there isn't a conclusive way to know if VIT works.

QUOTE:
"There are no specific tests to distinguish which patients will relapse after stopping VIT, but there is a higher risk in some patients than others. Relapse is less likely with 5 years than with 3 years of VIT.50,53Although most patients can safely discontinue immunotherapy after this period of time, some patients with a history of severe anaphylaxis with shock or loss of consciousness still might be at continued risk for a systemic reaction if VIT is stopped, even after 5 years of immunotherapy.46,47,52"
When I started this whole ordeal, the doctor told me that they would test my blood to make a determination. The nurses I've quizzed over the past 2 1/2 years have been pretty much stumped when asked for details. None has ever known, "How much venom is in a shot?" or "Why can't the venoms be mixed?" or "How does an allergy shot compare to a real sting?" One did mention an "antibody titer" when I asked how they would test to see if the allergy shots were working, but again, no details.

It's upsetting to me that the doctor I got switched to couldn't answer my question on how they'd know if my therapy is working. Her response was, "If you want to stop, let's stop." Who said anything about stopping? Why would I want to stop after having invested thousands of dollars out-of-pocket?! It irritates me to no end that a) I feel like I've been misled, b) I feel like I'm just an open wallet to them, and c) a basic question can't be answered by someone who is supposed to be educated on the matter. The doc said she had to "research" how venoms work because a skin test could show a false positive. After I got snarky with her on the phone, she finally said that rather than run up my bills — she admitted it! — with another skin test, let's plan on a blood test in 6 months when I'm at the 3-year mark.

The thing is… I think it's time to fight my addiction. As much as I'm curious and would love to share the results with you, my pocketbook's in bad shape and I just need to stop. I don't really need to know if there's serum venom-specific IgE in my blood or whatever it is they'd be looking for. I'm going to have to carry EpiPens all my life whether or not the therapy works. I just paid for a set of antigens to last through June, so I'll use them up and give a final VIT report then. 

NSAIDs increase reactions to bee stings

Honey Bee on Garlic Chives

Yesterday, four nurses were a little freaked out by the redness and swelling (larger than their palm) I showed after getting my allergy shots. "Hmmm… let me ask another nurse what she thinks," said one, then another, and the next. Then came a barrage of questions. Are you feeling okay? You're not having any other symptoms, are you? Did you ice? This amount of redness is normal for you? Are they itchy, did you scratch? Did you take an antihistamine? What kind?

After looking at the computer and seeing I get venom shots, the freak out calmed down a bit. Venom shot reactions can often be more intense than pollen shot reactions. But all the hullabaloo got me thinking. And then I remembered. I'd taken an NSAID for a headache the evening before.

One time, I took a migraine-strength NSAID the day before getting allergy shots, and ended up having what looked like a severe systemic reaction that sent me "back for treatment." Being sent to the back for anaphylaxis treatment set me back months in my therapy, so it was a very costly turn of events. There is some research that shows NSAIDs may provoke systemic allergic reactions to bee stings, and apparently it's true for VIT "stings" as well. Remember, a maintenance dose of venom is the equivalent of two stings.

VIT Report: 2-years of Allergy Shots Completed

The #honeybees abandon the oregano and Black-eyed Susans when the 'Autumn Joy' #sedum begins to bloom #inmygarden. #bees #beekeeping #stonecrop #rudbeckia #xeriscape #canoneos

A photo posted by BBHB (@backyardbee) on Aug 31, 2015 at 3:53pm PDT

Two years down. Hopefully just one more to go. Here's the damage to date:
Shots taken: 162
Miles Driven: 672
Out-of-Pocket: $4,741 (not including gas)
How much I saved by having insurance: $1,612
How much I spent to have insurance: UGH don't ask 

They Had Me at Honey

Drinks at Acorn

The REHYDRATOR ingredient list is cherry, aloe, cranberry, lime, and honey. 'nuff said. We ordered two.

A pretty drink which, strangely, I did not Instagram, I think it's the red one in the photo (from their Facebook page). We were served drinks that looked like the yellow one, I think. It's all kind of of a blur. Whatever it looked like, I took a sip… and then another. There was something in it that I could not identify. "What does aloe taste like?" I asked. I took a third sip. And then I knew. The thing that I could not identify was alcohol, lots of proofy alcohol. It wasn't the taste of alcohol that I identified, though. It was my heart that I felt starting to pound, pound, pound. What ensued was a bad case of Asian Flush. So bad that I contemplated using my EpiPen.

VIT Report: 2 Years Post-Anaphylaxis

#InBloom: the Chanticleer Pear produces a watery nectar that isn't attractive to honeybees. You'll see them gathering pollen, though, alongside foraging mason #bees, which are just emerging. Wasps and flies are attracted to the flowers' putrid smell so these trees are simply abuzz in #April if not deblossomed by an ill-timed (SO #CO) snowstorm. #photojojomacro #springtimeintheRockies #nature #303beekeeper

A photo posted by BBHB (@backyardbee) on Mar 30, 2015 at 8:53pm PDT

Two years ago today I received the life-changing sting that sent me down the path of bee Venom Immunotherapy. So far I've put 540 miles on the car and taken 147 allergy shots, about half the total number of miles & shots I expect it will take to complete the therapy. If I don't have any more adverse reactions to the therapy, I should finish by late-summer 2018. Until then, I have to carry epinephrine autoinjectors on me, the subject of today's post.

VIT Report: Building Up Again

In bloom: Silver Maples are an important source of early #pollen for honey #bees and native pollinators. #Tadaa #photojojomacro

A photo posted by BBHB (@backyardbee) on Feb 7, 2015 at 2:18pm PST

Finally! After being held at half-maintenance since November of 2013, the allergist has agreed to start building again. They will slowly increase my injections from 0.5 to 1 full cc. I get to pick how fast… how fast do I want to spend $100: twenty bucks twice a week for 2 1/2 weeks, or twenty bucks once a week for 5 weeks? They just re-ordered antigens for me, and that's about $800 out-of-pocket, so I'm inclined to take to the slow route.

I'm also still trying to figure out where the money is going to come from to cover the $385* $430 cost of epinephrine autoinjectors, and that's the generic version. Despite the look I got for carrying around expired Epi-pens, I'm just going to have to keep walking around with expired Epi-pens. Maybe I'll have it figured it out by the time beekeeping season really gets going.

VIT Report: One Year Into Venom Immunotherapy

It's been a year since I started VIT and here's the scoop. The nurses that I asked didn't seem to know but, from what I could find on the Internet, industry target for VIT seems to be 100μg per injection, which is a full cc. (Bees release 50–140μg of venom per sting.) My maintenance dose is currently half that (the computer screen there says 0.5cc) but the goal remains a full cc.

I've been held back because of the two reactions I had. Since we changed up where I get my injections (arm, arm, hip) I haven't had anything more than a local reaction, but I have no idea when I'll start building up again. It's at the doctor's discretion and the nurses won't fathom a guess. My guess is they'll milk the monthly income for quite a while.

At one of my monthly visits, the nurse discovered that the vial of mixed vespids venom was empty so I didn't get that injection that day. I waited for a call that new venom was ready but I never got the message. By the time I followed up myself, it had been too many days since my last m.vespid injection so they dropped me down "two doses." Where normally I would receive 0.5μg/ml, they would only give me 0.3μg, and 0.4μg the next visit. So it took me three months to get back to where I was, at my half-maintenance dose! Thanks, Verizon, your voicemail service is just awesome.

As it turned out, I exceeded some day-count for my 0.4μg build with the m.vespids and they made me do a twice-a-week protocol… Totally confusing, I know. My point is, the schedule is really structured, so if you're contemplating VIT it's important to adhere to it if you want to a) finish faster and b) keep costs down. Remember, it's $20 for one injection or $25 for two-or-more AND repeating doses means you deplete your antigen supply quicker. Refill = kaChing!

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More interesting reading: Clinical immunology review series: an approach to desensitization

354 miles and 90 venom shots: a year-end recap

The best advice my friend gave me on getting venom shots, "Pick a convenient location. You'll put a lot of miles on your car." So here we go, that's how I'll start this year's year-end recap.

Miles posted: 354 — 30 office visits, 90 venom shots, 1 adrenaline shot
Posts posted: 53 — 6 recipes, 5 rants, 4 because you asked, and 1 guest post
Hive count: 3 — 2 became 1 then 2 again; 1 of the 2 became 4; 2 were combined, and then one died
Bee stings: 1

A little housekeeping after 155hrs straight, sub-freezing temperatures.
Photograph courtesy of John the Beekeeper 

This picture shows that I was wrong about the cold snap killing the bees. Perhaps a testament to their survivor stock genes, they apparently were able to organize themselves into a proper cluster despite the plummeting temperatures. And now they are doing what bees are supposed to do, bringing out the dead and dumping them on the doorstep. It's a very good thing to see, because seeing dead bees placed in a pile means you have have live bees.

Speaking of doorsteps, I've just heard the thump! of a package being left on mine. I haven't ordered anything, so whatever it is, it's a surprise. And this brings me to my year-end wish for you, dear readers. May you find dead bees on their doorstep, and surprising and wonderful things on your doorstep, too. Over and out… see you some time next year.

Treatment of Anyphylactic Reaction to Allergy Shots: a Follow-Up

Just a Few Things I've Learned about Allergic Reactions to VIT

If the therapy goes without a hitch, these things don't come up. But since I've had hitches, here are some factoids for you.

• Allergic reaction to immunotherapy shots is actually quite common. 
• Symptoms are usually mild and can include scratchy throat, runny noise, and bloodshot eyes. The nurses will definitely be monitoring your blood pressure. 
• The treatment (epinephrine, steroid and antihistamines) makes it so you have no swelling or itching at the injection site(s). Nice!
• After a reaction (whether treated or not), you have to wait at least a full week before getting more venom shots. It's best to just wait for a nurse to call with the go-ahead, since the doctor has to review your case to lay the course for resuming.
• After the first reaction to immunotherapy, they drop you down a few doses and build up again normally; e.g.: drop from 1μg/ml down to 0.02μg, then build to 0.04μg, 0.06μg/ml…
• After the second reaction to immunotherapy, they drop you down a few doses and repeat that dose several times before building up conservatively; e.g.: 0.02μg, 0.02μg, 0.02μg, 0.03μg, 0.04μg, 0.05μg, 0.05μg…
• Please take those amounts in theory only. The actual dosing is rather confusing, and I could be off by a factor of 10.

Treatment of Anaphylaxis/Immunotherapy Reactions

Avalanche Management

Well, now I know what "for treatment" means. Two weeks ago I was supposed to have turned the car around and gone back 'for treatment." Today, when I really wanted a lozenge shortly after my triple-venom shots, I was taken to the back "for treatment."

VIT Report

Display of honeybee products at Nick's Garden Center

Have had a set back with my venom immunotherapy. My first maintenance doses triggered a systemic reaction. Large localized swelling and the tiniest, tiniest hint of wheezing, with coughing and a drippy nose. The nurse says I'm not allowed any more venom shots until the doctor has reviewed my incident report.

I was supposed to have turned around and gone back to the office with the first cough "for treatment," whatever that means. But the tickle in my throat was so slight. Besides, I was on a mission to get some special food for my kitty from the vet, so continued on my merry way. Even on the next day, while unhappy that my tricep felt like a water balloon, I just took some Benadryl and Advil. It wasn't until that night, when my elbow started to puff, that I became concerned. If a reaction moves past a joint, that's bad. [I guess I should say really bad, because all the other stuff, as slight as it was, was bad. I learned there's Protracted, Late-Phase and Biphasic Anaphylaxis. Whether elongated, delayed or in two phases, I just have to assume that I'm never quite in the clear.] Of course by the time my elbow started to hurt it was Sunday night, so I just took more Benadryl and Advil. The nurse says I should've gone to Urgent Care.

I wonder what's it's like to have healthcare like they do in Europe. To not have to think, "What's it going to cost me this time?" or "Can I afford another $350 bill?"