It all began while I was sitting in a chair talking to my doctor at the end of a routine office visit when she asked, “Do you have any other concerns about your health that we haven’t talked about?”
“Yeah. I was mowing a few weeks ago and got stung three times. After that all I wanted to do was sleep for two days.”
In a way that I’ve come to find endearing, but also tells me she’s concerned, her response was a simple, rising, “Oh!”
Yeah, something was wrong.
After a few moments furrowing her brow in thought she said, “I think you’re developing a severe allergic reaction. I’m going to prescribe you an epi-pen to go fill right now and to start carrying with you in case you get stung, and I’m going to schedule an appointment with an allergist.”
And so began the journey into venom immunotherapy.
What is Venom Immunotherapy?
This was a new treatment for me, something I didn’t know of until visiting my allergist, who conducted a series of skin prick tests to see if I had an allergic reaction to any of five different stinging insect venoms. If you’re not familiar with this type of testing. Essentially a very small, short needle is used to inject a small amount of an allergen into the skin. If it swells up, turns, red, gets itchy, or anything like that, then you are having a reaction. The amount of allergen injected and the size and severity of reaction provides some diagnostic information.
In the case of the venom, this required me to have three sets of five skin pricks, each with an increasing amount of allergen each time. If I didn’t react to any of these, congratulations, no allergy to the venom, beyond the trauma of the sting. I, as you may surmise, was not so lucky. I made it through the first two rounds of testing without a reaction, but on the third one the yellow jacket venom popped. Though the symptoms raised an alarm of an allergic reaction, the test confirmed it.
At this time my doctor said that because I didn’t react until the third time, my risk wasn’t as high as someone who reacted to the first test, but it was a concern, especially if I spend a lot of time outdoors. I’ve been stung over 40 times by yellow jackets in 20 years. I suspect it will happen again. Okay doc, what are my options?“You can continue to carry an epi-pen with you, which will help in case you get stung and have a bad reaction, but then you’ll want to get to a hospital as soon as possible. Or you can undergo immunotherapy to return your reaction to baseline.”
This is the moment where he went on to explain that by exposing my body to small amounts of this allergen for year after year, like Westy in the Princess Bride and I too could be immune to iocane powder. Wait, no, in my case it would be yellow jackets.
What we’re doing through this series of ongoing venom injections is to desensitizing my immune system so it stops going haywire every time I get stung.
What is the process like?
After the initial skin test, which took about 4 hours, I then had to start a series of antihistamines and immune suppressants to prepare my body for a rigorous induction period. After I was all medicated up, I visited the allergist’s office three times over four days, and received a total of ten injections, each one successively stronger than the last, to begin getting my immune system to react, with all the medications helping to alleviate any serious adverse reaction. Nothing serious happened, though at the end my arms were sore, swollen, and tender, feeling like I received a really bad sunburn.
At this point, after the initial treatment, my body was no longer at a high risk of developing a severe allergic reaction, and was ready to settle in for the long haul of one injection every four weeks for the next five years, at which time I had been exposed long enough and regularly enough that the therapy is considered permanent.
Those ongoing appointments take about forty-five minutes and have no appreciable side effects other than the slight prick and pain of the injection.
All in all, the worst part of this all of this were the medications for the initial treatment. Two of them can cause mood changes, and they ganged up on me for the time I was on them. I was not a pleasant person to be around, something that unfortunately is a side effect for everyone in my family. There is nothing more unstable than a four year old boy on prednisolone.
What is the cost?
I don’t know what the options are for those of you with universal healthcare, but in the United States it is covered by many insurance companies. If you want to find out if it is, ask your doctor for the ICD-9 or ICD-10 code for this treatment and all the related appointments and ask your insurance company if these procedures are covered, or work with the doctor’s office to have this screened with the insurance provider.When I had health insurance, the out of pocket cost went against my deductible until it was reached, after which there was no cost for the injections, and only a co-pay for my annual office visit.
Now that I no longer have insurance and pay directly, each injection is $30, a vial of venom is $507, and my annual allergist checkup, which includes a respiratory test, is $269, so $1,135 a year. The initial skin tests and induction protocol were a similar cost.
How do I get started?
Call your regular physician and talk with them about your concerns so you can choose the right options for you and your family and so they can connect you with the right specialist. Then see about having the skin test done and see what the right treatment is.It is a long road to go through this, with the appointments and ongoing injections, but I think that the treatment is worth it because, even though deaths from allergic stings are relatively rare in the U.S., just the removal of the pain and misery of a sting is worth it.
If you, your friends, or family members have any questions about this, let me know.
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From here the next episode is a followup interview with Joshua Cubista, recorded by David Bilbrey.
Until then, find ways to keep yourself happy and healthy so you can have a long life taking care of Earth, yourself, and each other.