B ROLL Dr. Andreae in clinic Stinging insects Mosquitoes Repellants with Deet Treating insect stings	OVERVIEW: For most of us, the biting and stinging insects of summer are just a minor annoyance, but for some people, they can represent a serious problem. University of Michigan Health System pediatrician Dr. Margie Andreae talks about summer insects, how to treat stings and bites, and when to be concerned. She also discusses West Nile Virus and the ticks that can cause Lyme disease.
Margie Andreae, MD Pediatrician University of Michigan Health System	MARGIE ANDREAE, MD: [AHN-dray] Stinging insects [01:00:26] For most people, summer insects are just a minor annoyance. There are a small set of people for which summer insects can be dangerous. Those are the people that have allergy to insect stings, usually from bees or wasps. [01:00:41] (:15)
	[01:00:46] The most common reaction to an insect sting from a bee or a wasp is redness and swelling at the sight, usually a small amount of swelling that doesn’t extend beyond a few inches from the bite, and pain... [01:01:03] (:17)
	[01:01:08] The vast majority of people will only have a localized reaction, however, 3-percent of the population may develop an allergic reaction. And this would be including symptoms of rash, hives, distant from the site of the bite. [01:01:25] (:17)
	[01:01:30] For individuals who develop an allergic reaction, they would want to make sure that they have Benadryl, and if they develop a more severe allergic reaction that would include difficulty breathing or swallowing, they need to seek emergency services, dialing 9-1-1. [01:01:47] (:17)
	Treating insect stings [01:01:57] The first thing to do when stung by a bee or a wasp is to look at the site to see if there’s any remaining stinger at the site, and the best way to remove the stinger is to use a firm object like a credit card to just sweep over the area and pull out the stinger. If you squeeze and try to pinch the stinger out, you may release more venom into the bite. [01:02:24] (:27)
	[01:02:29] For the majority of the people stung by bees and wasps, they’re going to develop a local reaction with redness and swelling and pain, and a good approach to treatment for those types of reactions include applying a cool compress, an ice pack, and also hydrocortisone cream directly to the sight of the insect sting. You can also use Benadryl in the oral form, as well as ibuprofen or Tylenol to relieve the pain. [01:03:00] (:31)
	Mosquitoes [01:03:10] The insect that we see causing problems that bring people into the clinic most frequently, in the pediatric clinic, are mosquitoes. Mosquito bites generally cause a localized reaction in most children and this is often concerning to parents, thinking that it’s a more severe reaction, such as an infection, and they will bring them in for evaluation or treatment. [01:03:38] (:28)
	[01:03:43] For a mosquito bite, the incidence of a severe reaction, such as a secondary infection, is pretty uncommon, though they would occur about three to four days after the insect bite at about the time you’d usually expect the normal reaction to be going away. And so that would be the time to be concerned with a mosquito bite. [01:04:08] (:25)
	West Nile Virus [01:04:18] We need to be concerned about mosquitoes causing West Nile Virus. It’s now present throughout the United States and it’s of most concern in individuals over the age of 50 for severe illness. [01:04:33] (:15)
	[01:04:38] For a very small number of people, approximately one out of 150 bitten by a mosquito that’s infected with the West Nile Virus, will develop a severe illness. The symptoms of a more severe illness include the initial flu-like symptoms that progress to more severe symptoms of severe headache, coma and sometimes seizures. [01:05:03] (:25)
	Protecting against mosquitoes [01:05:12] The best way to protect yourself against mosquitoes and mosquito-borne illnesses is to use repellants. The Centers for Disease Control recommends the use of DEET, which is in most of our over-the-counter insect repellants. This can be used safely on children down to the age of two months, and on adults. [01:05:38] (:26)
	[01:05:43] The concentration of DEET that’s most often recommended for children is 10-percent and up to 30-percent is safe for adults. The percent of concentration of DEET in a product is related to the length of time that it provides protection, not necessarily the strength or maximum protection against being bitten. For the 10-percent strength, it usually provides somewhere around two to three hours of protection against insect bites. [01:06:18] (:35)
	Avoiding summer insect bites [01:06:28] There are some additional things that people can do to avoid insect bites. For stinging insects, you want to avoid being around opened beverages that are sweetened. Those will attract stinging insects, and for mosquitoes you want to avoid having areas where they breed, which would include areas of standing water. So for backyards, you want to empty all your pools at the end of the day and not to leave any plants that would have standing water in them. [01:07:02] (:34)
	Ticks & Lyme disease [01:07:12] Another insect that we should be concerned about, particularly for people that live in the northeast and upper Midwest, is the tick The tick can carry Lyme disease and that’s the concern related to tick bites. [01:07:26] (:14)
	[01:07:31] Individuals at most risk for Lyme disease include those who spend a great deal of time outdoors, especially in wooded areas. We see an increase in the incidence of Lyme disease in individuals who are school-aged and also adults over 50. [01:07:47] (:16)
	[01:07:52] Lyme disease is an illness that typically presents initially with a rash at the location of the tick bite. About 80-percent of individuals will develop a rash and often it can be accompanied with flu-like symptoms of fever or headache, nausea and vomiting. Some individuals may get the flu-like symptoms alone, without the rash. [01:08:18] (:26)
	[01:08:23] There’s a small number who will go on to develop secondary illness or complications from Lyme disease, which most commonly affects large joints with joint pain and swelling. [01:08:34] (:11)
	[01:08:39] Any individual with a rash at a known tick bite should be evaluated for possible treatment and testing for Lyme disease. [01:08:46] (:07)