Discussion: Wasp/bee allergy and orienteering

After multiple encounters with wasp nests these past few years I've tested super positive for wasp stings which means that now an Epipen will become my new best friend. Does anybody have experience with orienteering with a severe wasp allergy? What's the best way you've found to carry an Epipen?
Thanks for any suggestions!

Doesn't Thierry have experience with that?

Lex Bundschuh and Jeff Saeger both have (alarming!) experiences in this regard. (Probably others as well.)

A very small fanny pack works well. Buckles around your waist. Just big enough to hold a twin pack of Epi pens and a few Benadryl capsules. Not one of these big things that also could hold snacks and water bottles.

Wife picked up one of these, but I haven't tried it yet

http://www.spibelt.com/products/spibelt/the-origin...

Not bulky. I am tempted to borrow it for a half marathon that requires you to carry a passport.

Sorry to hear that and while you probably know this stuff, here is some useful guidance as well as a link to a neat way to carry 2 Epipens. Hope this helps.

If you have a severe allergic (aka anaphylaxis) reaction, use the Epipen and seek immediate medical help for the following circumstances:
• Trouble breathing
• Feelings of faintness or dizziness
• Hives
• A swollen tongue
• A history of severe allergy reaction to insect stings
If you do not have severe allergy symptoms:
1. Remove the Stinger
• Scrape the area with a fingernail or use tweezers to remove it.
• Don't pinch the stinger -- that can inject more venom.
2. Control Swelling
• Ice the area.
• If you were stung on your arm or leg, elevate it.
• Remove any tight-fitting jewelry from the area of the sting.
3. Treat Symptoms
• For pain, take acetaminophen or ibuprofen.
• For itchiness, take an antihistamine.
4. Follow-Up
• It might take 2-5 days for the area to heal. Keep it clean to prevent infection.

Check out this website for a neat way to carry Epipens: http://www.concealedepipen.com

You could sew a pocket onto the inside of your o' jerseys. That would possibly less obnoxious than carrying an extra thingy around your waist. You can probably sew a lot of pockets relatively quickly if you don't worry too much about them looking pretty.

Could you stick it just above the bottom band of your bra?

I wouldn't want anybody feeling around my brassiere for an epi pen, personally (b/c sometimes the person administering the pen isn't the one afflicted).

perhaps the above spibelt or something modified like the phone holders people wear nowadays: http://www.hdaccessory.com/servlet/the-19717/galax...

Be ready for a whole nest of the buggers!

These little packs from Amphipod latch with a magnet so you can attach it to your waistbelt and it doesn't really bounce. Never used it for O+ before though.

It could be that wearing a pack latched with a magnet might not be so great for compass sports. I know that when combi-mitts started using little magnets instead of Velcro for latching back the finger coverings when not in use, they suddenly became useless for winter orienteering.

I haven't carried an epipen in it but the aforementioned Spibelt has been used by each of us to carry electronic and medical equipment and it's super comfortable. Wear it like a belt with the pocket in the back and you can't tell it's there.

You could consider the Auvi‑Q as an alternate to the EpiPen, if it is available to you. It is significantly smaller and rectangular - about the size of a smallish smart phone. I have only used the trainer version so I'm not sure about weight, but it seemed to me like it might be easier to carry.

http://www.auvi-q.com/

And carry 2 please. You need the backup.

Wow thanks so much for the support!! A little fanny pack sounds like a great idea! Or maybe I'll contact Trimtex and request special o-pants with an Epipen pocket! :P At least I have a few months until the wasps start getting angry so I have some time to experiment to find the right solution.

Yep I have experience with this. Sorry to hear you test positive. Have you had a bad reaction? I certainly tested positive (had the allergy since my first sting at age 4).
But I never suffered a life threatening reaction, where my breathing became difficult.
The new EPI are much easier to administer than the old ones. Jude sewed a pocket into my O pants to carry one. I must admit though, many times I have gone out without it. Please do not do that!
I would make sure you read over the instructions and understand exactly how to use the pen.
On a positive note, after 50 years of having allergic reactions, my allergy has disappeared. I believe the "cure" was a massive intrevenous dose of Benadryl at a country medical clinic in Red Deer, ALB.

At one point had a pair of triathlon nicks that had a pocket in the side for a gel but would fit an epipen. I'm not so worried about every lost second on most runs so I carry a little drink bottle belt with a pocket that fits the epipen. Nice being able to drink whenever you feel like it instead of waiting for the next drinks stop too :)
(Fortunately for me though, my allergies are food related, so for morning races, I often don't bother carrying it)

I use and spi belt to carry a phone and keys when running. I've not generally been a fan of bumbags, but this one works really well for me.

Wear it as Christina suggests.

I wear a Nathan hydration pack very similar to this one for long runs.

http://www.rei.com/product/850222/nathan-trail-mix...

You don't notice that it is there, and, since you won't need the water bottles, it will be very light. I would definitely suggest something back mounted like this to reduce risk of damage to the EPI-pen from terrain features.

I recall somebody (Lex?) having a pocket sewn into the back of her shirt, between the shoulder blades.

As mentioned above, please carry two. I am aware of several incidents where the first dose began to wear off after even just 15 minutes. And I am aware of a multitude of times when I've been out orienteering in places where I was much, much more than 15 minutes away from help.

I think the important thing if allergic is to also carry an antihistamine such as Benadryl. Thats what actually quells the allergic reaction. The epipen counters any swelling/airway constriction basically buying you time for an antihistamine to take effect but doesn't actually treat the underlying allergic response. And as noted, doesn't last that long. Better to carry the antihistamine too and take it asap if stung, saving the epipen in case of airway issues.

At least thats what I've been told....

I have to carry emergency food at all times and perhaps a blood glucose meter on very long courses (due to type 1 diabetes). So, while a packet of sweets and / or a pouch of fruit puree is more flexible than a long thin epi pen, and a meter is about the size of a pack of playing cards, I can offer some ideas that I've used. I often wear a pair of nylon trousers, bought from Moutntain Equipment Co-Op in 1992 - many tears from brambles etc, repaired with herringbone stitching over the years, but the thigh pockets are ideal for carrying up to 100g of sweets or fruit puree pouch, so I reckon one could carry an epi pen, the other carry anti-histamine tablets. Otherwise, a small bumbag (I have a Karrimor 2 litre one) would do - make sure you try any bumbag on with the sort of items you intend to carry. Being British, I can hardly bear even to type "fanny pack" without sniggering....

In addition, I wear a reflective velcro Up and Running strap, marked "Medic Alert" attached to my shoe laces - it pokes out from under velcro flap over laces. Something that a first aider could read if I wasn't able to explain.

Hmmm ... to me, a not-Brit, "bumbag" sounds way more ridiculous than "fanny pack"!

This won't help if you have been stung but---usually, before a bee stings, it will buzz for about 1 second. Take that 1 second as an opportunity to crush it before it actually stings. At the same time, MOVE. There is probably a ground nest that got disturbed by another runner so you want to get away from that area.

I can still picture that swarm of bees right were my foot was going during day 5 of Oringen 2008. I took several really quick steps to get away and crushed anything that even remotely felt like it could be a bee. Still got one sting but it could have been worse.

The medical bracelet thing is something often overlooked that shouldn't be. Super useful to the first-aid folks trying to save your life, or so I've been told. The idea of the tag on shoelaces seems unobtrusive and a good precaution.

To recap the essential advice here and provide a partial rebuttal to Clints assertion I offer the following:

For a local reacton to a bee sting (ie skin erythema around the sting site) then antihistamines will help symtomatically.

For a systemic ie severe allergic reaction (read on for the mechanistic basis to this) then it is EPIPEN. Antihistamine (both H1 and H2 type) in this setting has very limited value ( and a lack of evidence to support its use). Corticosteroids have greater value.

Why? Because in these type 1 hpersensitivty reactions, once the triggering IgE cross linking on the effector cells (granulated mast cells and basohpils) in a susceptible individual has occured, release of many different chemical mediators follows in an avalanche effect (FYI further eludication of the precise mechanisms has provded insights into this phenomena including cross-talk with the kallikrein - bradykinin system). The net result is essentially increased vascular permeability leading to swelling and haemodynamic compromise. Histamine at this juncture is a bit part player.

So the bottom line for an individual susceptible to severe allergic reactions is: CARRY AND BE PREPARED TO USE TWO EPIPENS
and seek immediate medical attention.
ps Alex's suggestion is right on the mark!

Thanks Bill, I was just relaying what I'd previously been told - good to have it rebutted... :-)

Should a susceptible individual use the Epipen immediately upon being stung? Or should its use wait until major symptoms such as difficulty breathing become apparent? I've had family members who had allergic reactions, but not necessarily every time they were stung. Since I lead youth groups in the backcountry we leaders know who has/needs epipens, but its not immediately apparent (to me) at what point in a 'situation' their use is called for.

Good questions!
In general the answer is yes EARLY INTERVENTION based on a couple of things:
1.There is no contraindication to use of Epinephrine in such circumstances (ie benefit outweighs potential risk)
2. Susceptible inidividuals generally become attuned to their prodromal symptoms ie harbingers of something bad is going to happen- TRUST this feeling!
3. Any impending hives, lip/tongue swelling, shortness of breath warrants immediate intervention - things can only go SOUTH from there!
Bottom line is that this is a judgement call with a low threshold for intervention. I know this sounds scary, however dealing aggressively with an impending medical emergency is a good thing to do. Plus in the backcountry do what ever you need to do that does not further harm the patient.
Hope this helps.

Bill, any advice on whether one should get tested based on a past mild allergic reaction? I got hives after a wasp sting 20 years ago, and haven't been stung by one since. Don't know whether that could progress to something life-threatening on the next go-round.

Tim hi, I'll ty and boil things down, however there are nuances in the art and science of Allergy medicine.
First the good news is that risk of a significant reaction diminishes over time and 20 years represents a signifcant derisking period.
Second, the 2 tests commonly performed (skin prick testing and blood IgE levels to hymenoptera venom) have reasonable sensitivity and specificity (80%) meaning they can detect hypersensitive individuals (20% flase positive rate thereabouts), however they are NOT predictive of severity of a reaction.
Third, there is a low predictiveness from one attack to another in any given individual with respect to severity of subsequent or prior attacks.
Done properly there is low risk with skin prick testing , so my advice would be to have both this and the IgE test done to reestablish a baseline.